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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
            
         
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
         
      
         Food and Drug Administration                                                                                             
            
         Federal Funds
         Salaries and ExpensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
         of space rental and related costs pursuant to Public Law 92â313 for programs and activities of the Food and Drug Administration
         which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
         and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
         on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107â188; [$3,083,408,000:]$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. 379jâ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 75â717), as amended by the Food Safety Modernization Act (Public Law 111â353), and shall be credited to this
         account and remain available until expended; $15,367,000 shall be derived from food reinspection fees authorized by section
         743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75â717), as amended by the Food Safety Modernization Act (Public
         Law 111â353), and shall be credited to this account and remain available until expended; and amounts derived from voluntary
         qualified importer program fees authorized by section 743 of the Federal Food, Drug, and Cosmetic Act (Public Law 75â717),
         as amended by the Food Safety Modernization Act (Public Law 111â353), and shall be credited to this account and remain available
         until expended]: Provided further, That, in addition 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.  
         Buildings and FacilitiesFor plans, construction, repair, improvement, extension, alteration, and purchase of fixed equipment or facilities of or used
         by the Food and Drug Administration, where not otherwise provided, [$5,320,000]$8,788,000, to remain available until expended.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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)
                  â324
                  â324
                  â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)
                  â3,330
                  â4,280
                  â4,354
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â64
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,663
                  1,641
                  1,684
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â46
                  â44
                  â44
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â19
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â44
                  â44
                  â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
                  â49
                  â49
                  â49
               
               
                  4033
                  Non-Federal sources
                  â1,252
                  â1,367
                  â1,788
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,301
                  â1,416
                  â1,837
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         [In millions of dollars]
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
          
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses
         (Legislative proposal, not subject to PAYGO)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.  
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â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)
                  
                  
                  â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
                  
                  
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â554
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  300
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â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
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other Services                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â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)
                  â7
                  â9
                  â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
                  â8
                  â8
                  â8
               
               
                  4190
                  Outlays, net (total)
                  â1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs,
            medical devices, and cosmetics (21 U.S.C. 346a, 356, 357, 376). These services are financed wholly by fees paid by the industries
            affected.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â554
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  36
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services Administration                                                                             
            
         Federal Funds
         Health Resources and Services
         Primary Health CareFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect
         to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,579,975,000, 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 104â73 and
         for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS'') pertaining to administrative
         claims made under such law.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
         Health WorkforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b)
         of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$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).  
         Maternal and Child HealthFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social
         Security Act, and section 712 of the American Jobs Creation Act of 2004, [$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.  
         Ryan White HIV/AIDS ProgramFor 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.  
         Health Care SystemsFor carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
         Research Act of 2005, [$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.  
         Rural HealthFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
         and Safety Act, the Cardiac Arrest Survival Act of 2000, and sections 711 and 1820 of the Social Security Act, $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.  
         Family PlanningFor 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.  
         Program ManagementFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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 [75â9915]
                  9
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0943]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1362]
                  1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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 [75â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
                  â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)
                  â8,638
                  â8,529
                  â8,272
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â93
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,681
                  6,186
                  5,719
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â42
                  â80
                  â80
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â45
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â80
                  â80
                  â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
                  â16
                  â52
                  â53
               
               
                  4033
                  Non-Federal sources
                  â29
                  â29
                  â28
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â45
                  â81
                  â87
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â45
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â14
                  â16
                  â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 75â0350â0â1â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 2011â2012 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution 
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     HPSL
                     $378,701,815
                  
                  
                     NSL
                     $171,324,184
                  
                  
                     PCL
                     $246,664,915
                  
                  
                     
                        
                     
                  
                  
                     LDS
                     $130,836,447
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
                  
                     Total
                     $927,527,361
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury Compensation                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0320â0â1â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
                  â4
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â4
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203, and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988 are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988 are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process Fund                                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â551
                  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 [75â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)
                  â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 109â148,
            to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration
            to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section
            319Fâ3(b) of the Public Health Service Act.  Additionally, authority is provided to address any unexpected claims that may
            arise under the Smallpox Emergency Personal Protection Act of 2003.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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)
                  â122
                  â401
                  â318
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing Account                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â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
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â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
                  â18
                  â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
                  â10
                  â10
                  â10
               
               
                  2263
                  Adjustments: Terminations for default that result in claim payments
                  â1
                  â1
                  â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. 104â299 and P.L. 104â208 authorize Health Resources and Services Administration (HRSA) to guarantee up to $160 million
            in private loans to health centers for the costs of developing and operating managed care networks or plans and for the construction,
            renovation and modernization of medical facilities. As required by the Federal Credit Reform Act of 1990, this financing account
            records all cash flows to and from the Government resulting from the Health Center Loan Guarantee program. The program account
            for this activity is displayed in the Health Resources and Services account (75â0350) as a line in the program and financing
            schedule. 
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â551
                  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
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Program AccountSuch sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the PHS Act.
      In addition, for administrative expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, [$2,807,000]$2,807,000.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â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 [91â0202]
                  
                  
                  â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)
                  â3
                  â59
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 75â0340â0â1â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
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  237999
                  Total downward reestimate subsidy budget authority
                  â12
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3510
                  Budget authority
                  3
                  3
                  
               
               
                  3590
                  Outlays from new authority
                  
                  3
                  
               
               
                  
                     
                  
               
            
         
      
      
          In 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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  13
                  13
                  
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Financing Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â552
                  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 [91â4300]
                  
                  
                  â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)
                  â31
                  â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
                  
                  â56
                  
               
               
                  4122
                  Interest on uninvested funds
                  â4
                  â3
                  
               
               
                  4123
                  Recoveries of defaulted loans
                  â7
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross financing auth and disbursements (total)
                  â11
                  â63
                  
               
               
                  4170
                  Financing disbursements, net (mandatory)
                  20
                  â50
                  
               
               
                  4190
                  Financing disbursements, net (total)
                  20
                  â50
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â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
                  â77
                  â15
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â18
                  â9
                  
               
               
                  2263
                  Terminations for default that result in claim payments
                  â1
                  â4
                  
               
               
                  2264
                  Other adjustments, net
                  
                  
                  â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
                  â7
                  â4
                  
               
               
                  2364
                  Other adjustments, net
                  
                  
                  â190
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  184
                  190
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â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 (-)
                  â126
                  â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
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Liquidating Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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
                  â5
                  â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)
                  â4
                  â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
                  â8
                  â7
                  
               
               
                  4180
                  Budget authority, net (total)
                  â4
                  â4
                  
               
               
                  4190
                  Outlays, net (total)
                  â4
                  â4
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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
                  â15
                  â8
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â4
                  â3
                  
               
               
                  2264
                  Other adjustments, net
                  
                  
                  â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
                  â8
                  â7
                  
               
               
                  2361
                  Write-offs of loans receivable
                  â21
                  â18
                  
               
               
                  2364
                  Other adjustments, net
                  10
                  
                  â324
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  346
                  324
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â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 (-)
                  â238
                  â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
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan Fund                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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. 
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â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
         Vaccine Injury Compensation Program Trust FundFor payments from the Vaccine Injury Compensation Program Trust Fund ("Trust Fund''), such sums as may be necessary for claims
         associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant to
         subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed [$6,477,000] $6,477,000 shall be available from the Trust Fund to the Secretary.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â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
                  â19
                  â19
                  â19
               
               
                  0501
                  Vaccine Injury Compensation Program Trust Fund
                  â185
                  â242
                  â242
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â204
                  â261
                  â261
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  3,214
                  3,289
                  3,420
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â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)
                  â207
                  â280
                  â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
                  â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. 99â660 and P.L. 100â203 and serves as a source of
            funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims for vaccine-related
            injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â551
                  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
               
               
                  
                     
                  
               
            
         
      
         Indian Health Service                                                                                                    
            
         Federal Funds
         Indian Health ServiceFor expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination Act, the Indian
         Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect to the Indian Health Service,
         [$3,978,974,000]$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 93â638, such individually identifiable health information relating to disabled children
         as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
         U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
         Indian Health Facilities account.   Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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 [75â0390]
                  â69
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0390]
                  69
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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
                  â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
                  â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)
                  â5,138
                  â5,331
                  â5,010
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â118
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  844
                  768
                  514
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â332
                  â82
                  â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
                  â82
                  â82
                  â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
                  â324
                  â368
                  â368
               
               
                  4033
                  Non-Federal sources
                  â823
                  â797
                  â797
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,147
                  â1,165
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â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
               
               
                  
                     
                  
               
            
         
      
          Indian Health Contract Support Costs
         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.   
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â3920â0â1â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)
                  
                  
                  â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. 93â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.
         
      
         Indian Health FacilitiesFor construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters
         for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular
         buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized
         by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care
         Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act
         with respect to environmental health and facilities support activities of the Indian Health Service, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
                  â8
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â551
                  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
                  â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
                  â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)
                  â551
                  â495
                  â491
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â7
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  526
                  540
                  536
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â21
                  â6
                  â6
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  16
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â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
                  â18
                  â6
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â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
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONS                                                                                                
            
         
         Administrative ProvisionsâIndian Health ServiceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
         3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
         5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
         and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
         in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
         5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
         Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
         care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
         recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
         providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
         to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
         Law 93â638, as amended: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
         purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
         by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
         approved by the House and Senate Committees on Appropriations through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization
         through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance
         Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance
         agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal
         year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule
         published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility
         for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting
         the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and
         enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health
         Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance
         with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant
         to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds
         were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total
         costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance:
         Provided further, That the appropriation structure for the Indian Health Service may not be altered without advance notification to the House
         and Senate Committees on Appropriations.    
         Centers for Disease Control and Prevention                                                                               
            
         Federal Funds
         CDC-Wide Activities and Program Support
         Immunization and Respiratory DiseasesFor carrying out titles II, III, [VII,] XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501
         of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
         HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis PreventionFor 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.  
         Emerging and Zoonotic Infectious DiseasesFor carrying out titles II, III, [VII,] and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality Act, and section 501 of the
         Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, [$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.  
         Chronic Disease Prevention and Health PromotionFor 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 111â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.  
         Birth Defects, Developmental Disabilities, Disabilities and HealthFor carrying out titles II, III, [VII,] XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities and health, [$18,476,000]$67,148,000.  
         Public Health Scientific ServicesFor carrying out titles II, [and] III, and XVII of the PHS Act and Public Law 111â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.  
         Environmental HealthFor carrying out titles II, III, [VII,] and XVII of the PHS Act with respect to environmental health, [$103,672,000]$126,126,000.  
         Injury Prevention and ControlFor 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.  
         National Institute for Occupational Safety and HealthFor carrying out titles II, III, [VII,] and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, 501, and 514 of the Federal Mine Safety and Health Act,
         section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22 of the Occupational Safety
         and Health Act, with respect to occupational safety and health, [$249,364,000]$271,911,000 shall be available from amounts available under section 241 of the PHS Act.  
         Energy Employees Occupational Illness Compensation ProgramFor 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 106â554.  
         Global HealthFor 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.  
         Public Health Preparedness and ResponseFor carrying out titles II, III, [VII,] and XVII of the PHS Act with respect to public health preparedness and response, and for expenses necessary to support activities
         related to countering potential biological, nuclear, radiological, and chemical threats to civilian populations, [$1,228,360,000]$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].  
         CDC-Wide Activities and Program SupportFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
                  â3
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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 [75â0350]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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 [75â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
                  â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)
                  â7,243
                  â6,825
                  â6,809
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â7
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â81
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,314
                  5,830
                  5,940
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â468
                  â460
                  â460
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â307
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  315
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â460
                  â460
                  â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
                  â629
                  â458
                  â881
               
               
                  4033
                  Non-Federal sources
                  â7
                  â7
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â636
                  â465
                  â890
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â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
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital Fund                                                                                                 
            
         
         The Consolidated Appropriations Bill, 2012 (P.L. 112â74, Division F) provided authorities equivalent to those provided in
            42 U.S.C. 231 for CDC to begin creating a Working Capital Fund. The Working Capital Fund will be used by CDC to achieve greater
            cost efficiencies across the administrative operations of the agency.
         
      
         Agency for Toxic Substances and Disease Registry
         toxic substances and environmental public healthFor necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
         in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA),
         as amended; [section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA), as amended;] and section 3019 of the Solid Waste Disposal Act, as amended, [$76,300,000]$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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)
                  â85
                  â113
                  â81
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  52
                  26
                  31
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â13
                  â14
                  â14
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â14
                  â14
                  â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
                  â9
                  â10
                  â10
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â7
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â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
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program Fund                                                                                   
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â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 (WTCâNYC DHSSâ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)
                  â146
                  â233
                  â226
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 111â347)
            on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the
            Program Administrator for the WTC Health Program.  The WTC Health Program provides quality care for WTC-related health conditions,
            conducts WTC research, and maintains a health registry to collect data on victims of the September 11, 2001, terrorist attacks.
            The amounts included for 2013 and 2014 Budget reflect estimated Federal obligations for the WTC Health Program. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â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
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         Federal Funds
         National Cancer InstituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer, [$5,068,864,000,]$5,125,951,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer Institute[â]âFrederick  Federally Funded Research and Development Center in Frederick, Maryland.   
         National Heart, Lung, and Blood InstituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
         and blood products, [$3,076,067,000] $3,098,508,000.   
         National Institute of Dental and Craniofacial ResearchFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, [$408,212,000]$411,515,000.   
         National Institute of Diabetes and Digestive and Kidney DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, [$1,792,107,000]$1,811,786,000.   
         National Institute of Neurological Disorders and StrokeFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, [$1,624,707,000]$1,642,619,000.   
         National Institute of Allergy and Infectious DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, [$4,495,307,000]$4,578,813,000.   
         National Institute of General Medical SciencesFor 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.   
         Eunice Kennedy Shriver National Institute of Child Health and Human DevelopmentFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development, [$1,320,600,000]$1,339,360,000.   
         National Eye InstituteFor 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.   
         National Institute of Environment Health SciencesFor 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.    
         National Institute on AgingFor carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,102,650,000]$1,193,370,000.   
         National Institute of Arthritis and Musculoskeletal and Skin DiseasesFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
         [$535,610,000]$540,993,000.   
         National Institute on Deafness and Other Communication DisordersFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, [$417,297,000]$422,936,000.   
         National Institute of Nursing ResearchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$144,153,000]$146,244,000.   
         National Institute on Alcohol Abuse and AlcoholismFor carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, [$457,104,000]$463,848,000.   
         National Institute on Drug AbuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,054,001,000]$1,071,612,000.   
         National Institute of Mental HealthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,479,204,000]$1,465,782,000.   
         National Human Genome Research InstituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$511,370,000]$517,319,000.   
         National Institute of Biomedical Imaging and BioengineeringFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, [$336,896,000]$338,892,000.   
         National Center for Complementary and Alternative MedicineFor carrying out section 301 and title IV of the PHS Act with respect to complementary and alternative medicine, [$127,930,000]$129,041,000.   
         National Institute on Minority Health and Health DisparitiesFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
         [$279,389,000]$283,299,000.   
         John E. Fogarty International CenterFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
         of the PHS Act), [$69,758,000]$72,864,000.   
         National Library of MedicineFor 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.   
         National Center for Advancing Translational SciencesFor 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.   
         Office of the DirectorFor 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.   
         Buildings and FacilitiesFor the study of, construction of, renovation of, and acquisition of equipment for, facilities of or used by NIH, including
         the acquisition of real property, [$125,308,000]$126,111,000, to remain available until expended.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
                  â16
                  â17
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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 [75â0350]
                  â9
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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
                  â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)
                  â36,568
                  â34,960
                  â34,713
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â52
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â952
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  33,051
                  32,411
                  32,504
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,151
                  â938
                  â938
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â530
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  743
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â938
                  â938
                  â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
                  â3,675
                  â3,168
                  â3,377
               
               
                  4033
                  Non-Federal sources
                  â112
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,787
                  â3,168
                  â3,377
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         1Assumes annualized continuing resolution
         (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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
                     â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Substance Abuse and Mental Health Services Administration                                                                
            
         Federal Funds
         Mental HealthFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
         Individuals with Mental Illness Act, [$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.   
          Substance Abuse TreatmentFor 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.  
          Substance Abuse PreventionFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$463,378,000]$175,560,000.  
         Health Surveillance and Program SupportFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health'', "Substance
         Abuse Treatment'', and "Substance Abuse Prevention'' in carrying out titles III, V, and XIX of the PHS Act and the Protection
         and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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 [75â0350]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,347
                  3,368
                  3,348
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [75â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
                  â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)
                  â3,487
                  â3,847
                  â3,669
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â44
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,125
                  2,899
                  2,835
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â241
                  â22
                  â22
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  229
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â22
                  â22
                  â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
                  â471
                  â253
                  â257
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â471
                  â253
                  â259
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and Quality                                                                               
            
         Federal Funds
         Healthcare Research and QualityFor carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
         Medicare Prescription Drug, Improvement, and Modernization Act of 2003, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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 [75â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)
                  â647
                  â1,044
                  â375
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  726
                  68
                  42
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â382
                  â293
                  â293
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â195
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  284
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â293
                  â293
                  â293
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  607
                  433
                  â225
               
               
                  3200
                  Obligated balance, end of year
                  433
                  â225
                  â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
                  â463
                  â839
                  â349
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Centers for Medicare and Medicaid Services                                                                               
            
         Federal Funds
         Grants to States for MedicaidFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â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)
                  â251,221
                  â267,231
                  â304,091
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â602
                  â645
                  â300
               
               
                  4123
                  Non-Federal sources
                  â85
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â687
                  â645
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  â21
                  â436
               
               
                  
                  Outlays
                  
                  â21
                  â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.
         
         Vaccines for Children (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     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
                  
                  
                     
                        
                     
                  
               
            
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â2â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  â21
                  â31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  â21
                  â31
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  â21
                  â31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  â21
                  â31
               
               
                  1930
                  Total budgetary resources available
                  
                  â21
                  â31
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  â21
                  â31
               
               
                  3020
                  Outlays (gross)
                  
                  21
                  31
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â21
                  â31
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â21
                  â31
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â405
               
               
                  4180
                  Budget authority, net (total)
                  
                  â21
                  â436
               
               
                  4190
                  Outlays, net (total)
                  
                  â21
                  â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.
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Proposals
                  
                  
                  â126
               
               
                  0801
                  Medicare Part B premiums
                  
                  
                  405
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  279
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  
                  
                  â126
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  
                  
                  â126
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  405
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  279
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations                                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â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)
                  â480
                  â788
                  â749
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â44
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), and the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152).
         
         The Budget includes an unobligated balance of $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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  80
                  97
                  102
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust FundsFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
         under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
         of 1965, section 278(d)(3) of Public Law 97â248, and for administrative expenses incurred pursuant to section 201(g) of the
         Social Security Act, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â0â1â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
                  â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)
                  â231,381
                  â249,773
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â7â1â571
                  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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â2â1â571
                  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)
                  
                  â127
                  â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
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement Organizations                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â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
                  â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)
                  â429
                  â528
                  â628
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  766
                  697
                  447
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â999
                  â1,100
                  â1,100
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â472
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  371
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,100
                  â1,100
                  â1,100
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â174
                  â334
                  â403
               
               
                  3200
                  Obligated balance, end of year
                  â334
                  â403
                  â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]
                  â411
                  â528
                  â628
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â472
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  371
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â571
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  138
                  174
                  182
               
               
                  
                     
                  
               
            
         
      
         Program ManagementFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
         XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
         Medicare [and] & Medicaid Services, not to exceed [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
                  â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)
                  â4,035
                  â5,744
                  â6,519
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â20
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â180
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,436
                  3,157
                  3,157
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â3,623
                  â4,251
                  â4,251
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,334
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1,706
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â4,251
                  â4,251
                  â4,251
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â799
                  â815
                  â1,094
               
               
                  3200
                  Obligated balance, end of year
                  â815
                  â1,094
                  â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
                  â3,240
                  â3,896
                  â5,217
               
               
                  4033
                  Non-Federal sources
                  â356
                  â473
                  â7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,596
                  â4,369
                  â5,224
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,303
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1,572
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â119
                  â44
                  â26
               
               
                  4123
                  Non-Federal sources
                  â30
                  â28
                  â944
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â149
                  â72
                  â970
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0515â0â1â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
                  â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
                  
                  â6,368
                  â3,779
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  â6,368
                  â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
                  â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
                  â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)
                  â9,065
                  â9,897
                  â9,992
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  â6,368
                  â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. 111â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. 111â148) extended funding for CHIP, providing
            appropriations through 2015.
         
      
         Center for Medicare and Medicaid Innovation                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â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)
                  â218
                  â993
                  â1,339
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  163
                  309
                  347
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â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
                  
                  â3
                  â4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â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)
                  
                  â125
                  â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. 111â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. 111â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.  
         
      
         Medicare Health Information Technology Incentive Payments, Recovery Act                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0508â0â1â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)
                  â3,822
                  â4,560
                  â5,460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  448
                  448
                  448
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,839
                  â1,898
                  â1,898
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â59
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,898
                  â1,898
                  â1,898
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â1,749
                  â1,450
                  â1,450
               
               
                  3200
                  Obligated balance, end of year
                  â1,450
                  â1,450
                  â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
                  â3,532
                  â4,560
                  â5,460
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â59
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  290
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  290
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Rate Review Grants                                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0112â0â1â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)
                  â22
                  â100
                  â80
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â148) amends Section 2794 of the Public Health Service Act and provides that the Secretary
            shall carry out a program to award grants to States for a five-year period beginning in fiscal year 2010.  The Grants to States
            for Health Insurance Premium Review program provides funding to help States develop or enhance their current rate review activities.
            The program provides $250,000,000 over the five-year period beginning with fiscal year 2010.  States may receive no less than
            $1,000,000 and no more than $5,000,000 in any one grant year. Grant recipients are required to submit data to the Secretary
            on health insurance rate trends. 
         
      
         Pre-Existing Condition Insurance Plan Program                                                                            
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â551
                  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)
                  â1,599
                  â2,355
                  â983
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â98
                  â199
                  â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. 111â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  18
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Early Retiree Reinsurance Program                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â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)
                  â1,950
                  â147
                  â23
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â24
                  â75
                  
               
               
                  4190
                  Outlays, net (total)
                  1,926
                  72
                  23
               
               
                  
                     
                  
               
            
         
      
      
         The Affordable Care Act (P.L. 111â148) authorized and appropriated $5 billion for the Early Retiree Reinsurance Program (ERRP).
            ERRP provides reimbursement to participating sponsors of certified plans that provide health benefits to early retirees (age
            55 and older and not eligible for Medicare), their spouses, and surviving spouses and dependents.  Reimbursement is equal
            to 80 percent of the actual cost of health expenses paid for an individual (net of price concessions) between a cost threshold
            of $15,000 and cost limit of $90,000 beginning in 2010.  The cost threshold and cost limit are adjusted for inflation each
            year based on the Medical Care Component of the consumer price index for all urban consumers.  Reimbursements to sponsors
            shall be used to reduce the sponsor's health benefit or premium costs, provide premium and cost sharing relief to plan participants,
            or both. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  12
                  12
               
               
                  
                     
                  
               
            
         
      
         Affordable Insurance Exchange Grants                                                                                     
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â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)
                  â167
                  â1,457
                  â2,061
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â148) provides amounts necessary to enable the Secretary to award grants to States beginning no later than
            March 23, 2011, and allows for renewal grants through January 1, 2015.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  44
                  62
                  63
               
               
                  
                     
                  
               
            
         
      
         Reduced Cost Sharing for Individuals Enrolling in Qualified Health PlansFor carrying out, except as otherwise provided, sections 1402 and 1412 of the Patient Protection and Affordable Care Act (Public
            Law 111â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.  
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0126â0â1â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)
                  
                  
                  â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. 111â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. 111â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.  
         
      
         Risk Corridors Program Payments                                                                                          
            
         
         Risk Adjustment Program Payments                                                                                         
            
         
         Transitional Reinsurance Program                                                                                         
            
         
         Consumer Operated and Oriented Plan Program Contingency Fund                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â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 [75â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)
                  
                  â30
                  â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 75â0524â0â1â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.
            112â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. 111â148). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  25
                  22
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â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 [75â0524]
                  
                  â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
                  â400
                  â2,278
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  â400
                  â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)
                  â38
                  â254
                  â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
                  â400
                  â2,275
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  38
                  254
                  175
               
               
                  4180
                  Budget authority, net (total)
                  â400
                  â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 75â0118â0â1â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. 111â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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â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
                  
                  â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
                  â114
                  â174
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â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)
                  â94
                  â584
                  â422
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,601
                  1,326
                  922
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â692
                  â578
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â692
                  114
                  174
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â692
                  â578
                  â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
                  â34
                  â244
                  â174
               
               
                  4122
                  Interest on uninvested funds
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross financing auth and disbursements (total)
                  â37
                  â244
                  â174
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â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.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â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 (-)
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing Account                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4482â0â3â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
                  â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)
                  
                  â67
                  â106
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  114
                  10
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  
                  â43
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â43
                  39
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  
                  â43
                  â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
                  
                  â25
                  â39
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4482â0â3â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
         Federal Hospital Insurance Trust Fund                                                                                    
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â2,441
                  â2,573
                  â3,954
               
               
                  0501
                  Federal Hospital Insurance Trust Fund
                  5
                  
                  
               
               
                  0502
                  Federal Hospital Insurance Trust Fund
                  â244,733
                  â245,479
                  â263,389
               
               
                  0503
                  Federal Hospital Insurance Trust Fund
                  â8,646
                  â28,828
                  â15,596
               
               
                  0504
                  Federal Hospital Insurance Trust Fund
                  
                  â600
                  â821
               
               
                  0505
                  Federal Hospital Insurance Trust Fund
                  
                  600
                  821
               
               
                  0506
                  Federal Hospital Insurance Trust Fund
                  
                  303
                  329
               
               
                  0507
                  Federal Hospital Insurance Trust Fund
                  
                  â303
                  â329
               
               
                  0508
                  Federal Hospital Insurance Trust Fund
                  
                  
                  324
               
               
                  0509
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â806
               
               
                  0510
                  Health Care Fraud and Abuse Control Account
                  â310
                  â312
                  â311
               
               
                  0511
                  Health Care Fraud and Abuse Control Account
                  â1,290
                  â1,243
                  â1,219
               
               
                  0512
                  Health Care Fraud and Abuse Control Account
                  
                  473
                  685
               
               
                  0513
                  Health Care Fraud and Abuse Control Account
                  
                  â303
                  â329
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â257,415
                  â278,265
                  â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
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â83
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â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
                  
                  â6
                  
               
               
                  1132
                  Appropriations temporarily reduced
                  â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)
                  â263,855
                  â276,905
                  â282,186
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â436
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  24,209
                  24,178
                  24,931
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1
                  â1
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
                  â263,855
                  â276,905
                  â282,186
               
               
                  4500
                  Health Care Fraud and Abuse Control Account
                  â1,488
                  â1,714
                  â1,614
               
               
                  4500
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â482
               
               
                  4599
                  Outgo under current law (-)
                  â265,343
                  â278,619
                  â284,282
               
               
                  
                  Proposed legislation:
               
               
                  5500
                  Health Care Fraud and Abuse Control Account
                  
                  â303
                  â329
               
               
                  5500
                  Health Care Fraud and Abuse Control Account
                  
                  473
                  685
               
               
                  5599
                  Outgo under proposed legislation (-)
                  
                  170
                  356
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â265,343
                  â278,449
                  â283,926
               
               
                  7625
                  Federal Hospital Insurance Trust Fund
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  7699
                  Total adjustments
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â7â7â571
                  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)
                  
                  
                  â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â2â7â571
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  600
                  821
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  â600
                  â821
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â4â7â571
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  â303
                  â329
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  303
                  329
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control AccountIn 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â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
                  â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)
                  â1,488
                  â1,714
                  â1,614
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â41
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  â473
                  â685
               
               
                  
                  Outlays
                  
                  â473
                  â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. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Medicare, Medicaid, and CHIP that will supplement the
            mandatory funds made available by P.L. 104â191 and subsequent Acts.  See additional discussion in the Budget Process chapter
            in the Analytical Perspectives volume.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â571
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  333
                  405
                  405
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account                                                                              
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â2â7â571
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare Program Integrity savings
                  
                  â430
                  â476
               
               
                  0002
                  SSA Program integrity savings
                  
                  â43
                  â209
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.6)
                  
                  â473
                  â685
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  â473
                  â685
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  â473
                  â685
               
               
                  1930
                  Total budgetary resources available
                  
                  â473
                  â685
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  â473
                  â685
               
               
                  3020
                  Outlays (gross)
                  
                  473
                  685
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â473
                  â685
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â473
                  â685
               
               
                  4180
                  Budget authority, net (total)
                  
                  â473
                  â685
               
               
                  4190
                  Outlays, net (total)
                  
                  â473
                  â685
               
               
                  
                     
                  
               
            
         
      
      
         The mandatory proposal included in the Budget is estimated to achieve additional savings.
      
         Health Care Fraud and Abuse Control Account                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â4â7â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)
                  
                  â303
                  â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. 
         
         Proposed Additional Mandatory Funding for HCFAC
         
            
               
                  
                     
                        
                     
                  
                  
                     
                  
                  
                     ($Mil)
                     FY 2013
                     FY 2014
                  
                  
                     
                        
                     
                  
                  
                     
                  
                  
                     HHS-CMS
                     161
                     178
                  
                  
                     HHS-OIG
                     73
                     78
                  
                  
                     DOJ
                     69
                     73
                  
                  
                     
                        
                     
                  
                  
                     
                     
                     
                  
                  
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Additional Mandatory Funding
                     303
                     329
                  
                  
                     
                        
                     
                  
                  
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â4â7â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
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
                  
                  
                  â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
                  â3,270
                  â3,148
                  â3,042
               
               
                  0501
                  Federal Supplementary Medical Insurance Trust Fund
                  6
                  
                  
               
               
                  0502
                  Federal Supplementary Medical Insurance Trust Fund
                  â231,232
                  â251,238
                  â266,390
               
               
                  0503
                  Federal Supplementary Medical Insurance Trust Fund
                  â1,860
                  â1,812
                  
               
               
                  0504
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  11,898
               
               
                  0505
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â2,550
               
               
                  0506
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â13,037
               
               
                  0507
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â302
                  â361
                  â328
               
               
                  0508
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â55,745
                  â63,545
                  â71,471
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â292,403
                  â320,104
                  â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
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
                  â76
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â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
                  
                  â4
                  
               
               
                  1132
                  Appropriations temporarily reduced
                  â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
                  
                  
                  â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)
                  â235,955
                  â256,228
                  â257,570
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.  
         
         The status of the trust fund is as follows.  In addition, the Budget includes a package of proposals that improve Medicare's
            sustainability by promoting high-quality, efficient care; aligning payments with the costs of providing care; encouraging
            beneficiaries to seek high-value services; and reducing the Federal subsidy of Medicare costs for those beneficiaries who
            can most afford them.  
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â571
                  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
                  
                  
                  â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
                  â235,955
                  â256,228
                  â257,570
               
               
                  4500
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â57,960
                  â63,922
                  â71,839
               
               
                  4500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â15,587
               
               
                  4599
                  Outgo under current law (-)
                  â293,915
                  â320,150
                  â344,996
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â293,915
                  â320,150
                  â344,996
               
               
                  7625
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  7699
                  Total adjustments
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â7â7â571
                  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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â0â7â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)
                  â57,960
                  â63,922
                  â71,839
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â409
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â0â7â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
               
               
                  
                     
                  
               
            
         
      
         Allocations Received from Other Accounts                                                                                 
            
         
         Note.âObligations incurred under allocations from other accounts are included in the schedule of the parent appropriation
            as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."
         
      
         Administration for Children and Families                                                                                 
            
         Federal Funds
         Temporary Assistance for Needy Families                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â609
                  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
                  â18
                  â15
                  â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)
                  â16,136
                  â16,848
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â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. 112â175).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â609
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  15
                  15
                  15
               
               
                  
                     
                  
               
            
         
      
         Temporary Assistance for Needy Families                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â4â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â0â1â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)
                  â678
                  â876
                  â776
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  612
                  612
                  612
               
               
                  
                  Outlays
                  678
                  876
                  776
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â319
               
               
                  
                  Outlays
                  
                  
                  â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.
         
      
         Contingency Fund                                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â4â1â609
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  
                  
                  â319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â319
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â319
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â319
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â319
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â319
               
               
                  3020
                  Outlays (gross)
                  
                  
                  289
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â30
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â30
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â319
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â289
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â319
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â289
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support ProgramsFor [making payments to States or other non-Federal entities under] 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â0â1â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)
                  â3,960
                  â4,001
                  â4,043
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â341
                  â300
                  â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
                  â3
                  â7
                  â8
               
               
                  4180
                  Budget authority, net (total)
                  3,836
                  4,004
                  4,065
               
               
                  4190
                  Outlays, net (total)
                  3,957
                  3,994
                  4,035
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support Programs                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â4â1â609
                  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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
         Low Income Home Energy AssistanceFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1502â0â1â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
                  â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)
                  â3,817
                  â3,704
                  â2,936
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1502â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Refugee and Entrant AssistanceFor necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality
         Act and section 501 of the Refugee Education Assistance Act of 1980, 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â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
                  â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)
                  â802
                  â892
                  â952
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â609
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  45
                  54
                  64
               
               
                  
                     
                  
               
            
         
      
         Supporting Health Families and Adolescent DevelopmentFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â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
                  
                  
                  â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
                  â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)
                  â476
                  â511
                  â525
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 111â148). This account also includes
            a new initiative to prevent pregnancy among youth in foster care.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Supporting Healthy Families and Adolescent Development                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â4â1â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â4â1â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
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â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)
                  â2,828
                  â2,908
                  â2,916
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â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. 112â175).
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â4â1â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)
                  
                  
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â4â1â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
               
               
                  
                     
                  
               
            
         
      
         Payments to States for the Child Care and Development Block GrantFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â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
                  â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)
                  â2,200
                  â2,286
                  â2,442
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Social Services Block GrantFor making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph
         for a State to carry out State programs pursuant to title XX-A of such Act shall be 10 percent.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â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 [75â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)
                  â1,715
                  â1,964
                  â2,062
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â506
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  7
                  7
                  7
               
               
                  
                     
                  
               
            
         
      
         Children and Families Services ProgramsFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, [the Developmental Disabilities Assistance and Bill of Rights Act,] the Head Start Act, the Child Abuse Prevention and Treatment Act, sections 303 and 313 of the Family Violence Prevention
         and Services Act, the Native American Programs Act of 1974, title II of the Child Abuse Prevention and Treatment and Adoption
         Reform Act of 1978 (adoption opportunities), the Abandoned Infants Assistance Act of 1988, [section 291 of the Help America Vote Act of 2002,] part B-1 of title IV and sections 413, 1110, and 1115 of the Social Security Act; for making payments under the Community
         Services Block Grant Act ("CSBG Act''), sections 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113â2, the
            Disaster Relief Appropriations Act, 2013 (no language shown).
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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 [75â0140]
                  
                  100
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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
                  â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)
                  â9,909
                  â9,842
                  â10,461
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â123
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,626
                  6,793
                  7,490
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â7
                  â10
                  â10
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â6
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â10
                  â10
                  â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
                  â49
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â49
                  â24
                  â24
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â5
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â1
                  â1
                  â1
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â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)
                  â73
                  â86
                  â84
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  60
                  52
                  46
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â5
                  â5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5
                  â5
                  â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
                  â19
                  â25
                  â25
               
               
                  4123
                  Non-Federal sources
                  â1
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â20
                  â26
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â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. 112â175). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â609
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  62
                  70
                  70
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and PermanencyFor [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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â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
                  â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)
                  â6,847
                  â6,744
                  â6,899
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â87
                  â3
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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.â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.â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.â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â609
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and Permanency                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â4â1â609
                  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)
                  
                  
                  â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.
         
      
         Administration for Community Living                                                                                      
            
         Federal Funds
         Aging and Disability Services Programs
         (including transfer of funds)For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA''), [section 398 and title] 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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 [12â3507]
                  â2
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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 [75â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
                  â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
                  â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)
                  â1,493
                  â1,499
                  â1,889
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  691
                  707
                  958
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â37
                  â18
                  â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
                  â18
                  â18
                  â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
                  
                  
                  â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
                  â28
                  â29
                  â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.âThe reimbursable program (HCFAC) in the Administration on Aging (AoA) reflects the actual distribution of the allocation
            account for 2012.  Future allocations will be determined annually, and are not estimated in the current budget.
         
         
         This account provides funding for formula grant programs that provide nutrition, supportive services and caregiver support
            services through a network of aging-related organizations to help predominantly older Americans, with the assistance of their
            caregivers, maintain their dignity and independence in their homes and communities.  The Budget proposes to transfer the Senior
            Community Services Employment Program (SCSEP), authorized under title V of the Older Americans Act, from the Department of
            Labor to the Department of Health and Human Services (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
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Departmental Management                                                                                                  
            
         Federal Funds
         Office of the Secretary
         general departmental managementFor 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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â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)
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  474
                  477
                  301
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other accts [75â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
                  â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)
                  â860
                  â635
                  â815
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  623
                  710
                  596
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â226
                  â233
                  â233
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â134
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  127
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â233
                  â233
                  â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)
                  â219
                  â235
                  â286
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â125
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  106
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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)
                  â34
                  â9
                  â9
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects the actual distribution
            of the allocation account for 2012.  Future allocation will be determined annually, and are not estimated in the current budget.
         
         
         General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
            to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
            activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
            promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
            Prevention and Public Health Fund.  This includes funding the continuation of grants for medically accurate and age appropriate
            programs to reduce teen pregnancy, including funds for research, demonstration grants, and replication of programs that have
            been proven effective through rigorous evaluation to reduce teen pregnancy. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Office for Civil RightsFor expenses necessary for the Office for Civil Rights, [$38,966,000] $42,205,000.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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)
                  â44
                  â48
                  â49
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12
                  11
                  11
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â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
                  â1
                  
                  
               
               
                  4033
                  Non-Federal sources
                  â4
                  â6
                  â7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â5
                  â6
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Office of the National Coordinator for Health Information TechnologyFor expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts,
         and cooperative agreements for the development and advancement of interoperable health information technology, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â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
                  â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)
                  â648
                  â632
                  â441
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â30
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  977
                  414
                  59
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â44
                  â23
                  â3
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  30
                  20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â23
                  â3
                  â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
                  â78
                  â52
                  â64
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â78
                  â52
                  â65
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 111â5, Title XIII), for the purpose of addressing
            strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private
            adoption of health information technology.  
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â551
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Office of Medicare Hearings and AppealsFor expenses necessary for [administrative law judges responsible for hearing cases under title XVIII of the Social Security Act (and related provisions
         of title XI of such Act), $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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â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
                  â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)
                  â70
                  â86
                  â82
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â72
                  â72
                  â82
               
               
                  4190
                  Outlays, net (total)
                  â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  466
                  490
                  514
               
               
                  
                     
                  
               
            
         
      
         Public Health and Social Services Emergency Fund
         (including transfer of funds)For expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical,
         and cybersecurity threats to civilian populations, and for other public health emergencies, [$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 111â117, up to $415,000,000
         shall be available for expenses necessary to support advanced research and development pursuant to section 319L of the PHS
         Act, and other administrative expenses of the Biomedical Advanced Research and Development Authority to support additional
         advanced research and development: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures may be used and shall
         be in addition to any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in
         the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act.]
      In addition, for expenses necessary for replacement of building leases and associated renovation costs for Public Health Service
         agencies and other components of the Department of Health and Human Services, including relocation and fit-out costs, [$17,000,000] $41,000,000, to remain available until expended.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113â2, the
            Disaster Relief Appropriations Act, 2013 (no language shown).
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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 [75â0343]
                  â3
                  â3
                  â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 [75â1534]
                  
                  â500
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â1536]
                  
                  â100
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0128]
                  
                  â5
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â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
                  â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)
                  â1,795
                  â1,889
                  â1,999
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â120
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â28
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,455
                  4,931
                  3,873
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â290
                  â241
                  â241
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â35
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  84
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â241
                  â241
                  â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
                  â81
                  â60
                  â60
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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.
         
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust Fund                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â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)
                  â3
                  â10
                  â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
                  â30
                  â76
                  â125
               
               
                  4190
                  Outlays, net (total)
                  â27
                  â66
                  â90
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF).  Beginning in FY 2011, a total
            of 20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health
            and Human Services (HHS).  As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
            from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
            and build research and data capacity for comparative clinical effectiveness research.  Transferred funds will be distributed
            to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out these activities.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â552
                  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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â552
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Prevention and Wellness Fund, Recovery Act                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0144â0â1â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)
                  â14
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â5).  The
            Prevention and Wellness Fund administers evidence-based clinical and community-based prevention and wellness strategies. 
            
         
      
         Nonrecurring Expenses Fund                                                                                               
            
         
         The Nonrecurring Expenses Fund is a no-year account that captures expired unobligated balances from discretionary accounts
            prior to cancellation. The Fund will be used for capital acquisition, including facilities infrastructure and information
            technology infrastructure.
         
      
         Health Insurance Reform Implementation Fund                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â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)
                  â264
                  â318
                  â163
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services.  The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â551
                  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
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  16
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0116â0â1â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 [75â0142]
                  â20
                  
                  â25
               
               
                  1220
                  Appropriations transferred to other accts [75â1700]
                  â12
                  
                  
               
               
                  1220
                  Appropriations transferred to other accts [75â0943]
                  â809
                  
                  â755
               
               
                  1220
                  Appropriations transferred to other accts [75â9912]
                  â30
                  
                  â105
               
               
                  1220
                  Appropriations transferred to other accts [75â0350]
                  â37
                  
                  â57
               
               
                  1220
                  Appropriations transferred to other accts [75â1362]
                  â92
                  
                  â58
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â250
                  â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)
                  
                  â110
                  â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. 111â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.  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0116â0â1â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
                  
               
               
                  
                     
                  
               
            
         
      
         Pregnancy Assistance Fund                                                                                                
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â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)
                  â26
                  â25
                  â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.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Section 241 Evaluation Transactions Account                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â3902â0â1â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)
                  
                  â530
                  â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
                  
                  â530
                  â1,331
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health Service Act (PHS) Evaluation Transactions account supports the execution of section 241 of the PHS Act.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â3902â0â1â552
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  530
                  1,331
               
               
                  
                     
                  
               
            
         
      
         Program Support Center                                                                                                   
            
         Federal Funds
         Retirement Pay and Medical Benefits for Commissioned OfficersFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
         under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
         personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year.  Note.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution.
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â0â1â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
                  
                  â31
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  524
                  522
                  551
               
               
                  3011
                  Obligations incurred, expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â453
                  â561
                  â549
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  524
                  522
                  551
               
               
                  
                  Outlays
                  453
                  561
                  549
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1
               
               
                  
                  Outlays
                  
                  
                  â1
               
               
                  Total:
               
               
                  
                  Budget Authority
                  524
                  522
                  550
               
               
                  
                  Outlays
                  453
                  561
                  548
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â0â1â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
               
               
                  
                     
                  
               
            
         
      
         Retirement Pay and Medical Benefits for Commissioned Officers                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â4â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.6)
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â1
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â1
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0170â0â1â551
                  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)
                  â36
                  â29
                  â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
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  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
                  
                  
                  â2
               
               
                  
                  Outlays
                  
                  
                  â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. 108â375, section 725).
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0170â2â1â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct Program Activity
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â2
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â2
               
               
                  3020
                  Outlays (gross)
                  
                  
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â2
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â2
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â2
               
               
                  
                     
                  
               
            
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9913â0â1â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.
         
      
         HHS Service and Supply Fund                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
                  â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)
                  â842
                  â1,568
                  â1,103
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â67
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  509
                  25
                  25
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â481
                  â285
                  â285
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  196
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â285
                  â285
                  â285
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â66
                  224
                  â260
               
               
                  3200
                  Obligated balance, end of year
                  224
                  â260
                  â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
                  â1,012
                  â1,084
                  â1,103
               
               
                  4033
                  Non-Federal sources
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,019
                  â1,084
                  â1,103
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  196
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â177
                  484
                  
               
               
                  4190
                  Outlays, net (total)
                  â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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â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
         Miscellaneous Trust Funds                                                                                                
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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
                  â94
                  â91
                  â91
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  3
                  6
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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)
                  â60
                  â41
                  â56
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
               
               
                  
                     
                  
               
            
         
      
      
         (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     
                     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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â551
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  27
                  27
                  27
               
               
                  
                     
                  
               
            
         
      
         Office of the Inspector General                                                                                          
            
         Federal Funds
         Office of Inspector GeneralFor expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations,
         in carrying out the provisions of the Inspector General Act of 1978, [$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.â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. 112â175). The amounts
            included for 2013 reflect the annualized level provided by the continuing resolution as well as amounts from P.L. 113â2, the
            Disaster Relief Appropriations Act, 2013 (no language shown).
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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 [75â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
                  â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)
                  â336
                  â407
                  â412
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  56
                  51
                  61
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â73
                  â61
                  â61
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â27
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â61
                  â61
                  â61
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â12
                  â5
                  â10
               
               
                  3200
                  Obligated balance, end of year
                  â5
                  â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
                  â66
                  â140
                  â132
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â157
                  â201
                  â200
               
               
                  4123
                  Non-Federal sources
                  â20
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â177
                  â213
                  â212
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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.  
         
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â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
               
               
                  
                     
                  
               
            
         
      
                                                                                                                                  
            
         
         Allocations Received from Other Accounts                                                                                 
            
         
         Note.âObligations incurred under allocations from other accounts are included in the schedules of the parent appropriations
            as follows: Centers for Medicare and Medicaid Services "Health Care Fraud and Abuse Control Account."
         
      
         GENERAL FUND RECEIPT ACCOUNTS                                                                                            
            
         (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2012 actual
                  2013 CR
                  2014 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  75â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  93
                  90
                  90
               
               
                  75â274530
                  Health Education Assistance Loans, Downward Reestimates of Subsidies
                  12
                  
                  
               
               
                  75â310700
                  Federal Share of Child Support Collections
                  789
                  852
                  831
               
               
                  Legislative proposal, subject to PAYGO
                  
                  
                  4
               
               
                  75â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:
               
               
                  75â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  â27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  â27
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         GENERAL PROVISIONS                                                                                                       
            
         SEC. 201.  Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses when specifically approved by the Secretary.[SEC. 202.  The Secretary shall make available through assignment not more than 60 employees of the Public Health Service to assist in
      child survival activities and to work in AIDS programs through and with funds provided by the Agency for International Development,
      the United Nations International Children's Emergency Fund or the World Health Organization.]SEC. [203]202.  None of the discretionary funds appropriated in this title [Act for the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Substance Abuse and Mental
      Health Services Administration] shall be used to pay the salary of an individual, through a grant or other extramural mechanism, at a rate in excess of Executive
      Level II.SEC. [204]203.  Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than [3.2]3.0 percent, of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly,
      or by grants or contracts) of the implementation and effectiveness of such programs.'
      			
      (transfer of funds)SEC. [205]204.  Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of
      1985) which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but
      no such appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [206]205.  The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [207]206.  Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research'' account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. [208]207.  None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. [209]208.  Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. [210]209.  None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the
      Medicare Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including
      a Provider Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage
      of, or provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. [211]210.  In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year [2013] 2014:
      (1)  The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State
         Department Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission
         to ensure that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign
         Service Act of 1980 and other applicable statutes administered by the Department of State.
      
      (2)  The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
         to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
         for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
         functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
         and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
         through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
         foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
         of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
         chronic and environmental diseases, and other health activities abroad.
      
      (3)  The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
         benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
         4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
         comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
         percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
         official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
         the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
         Service Act of 1980, to individuals serving in the Foreign Service.
      SEC. [212]211. (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director'') may use funds available under section 402(b)(7)
      or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
      out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
      in such section 402(b)(12).
      (b) Peer Review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      SEC. [213]212.  Funds which are available for Individual Learning Accounts for employees of CDC and the Agency for Toxic Substances and Disease
      Registry ("ATSDR'') may be transferred to appropriate accounts of CDC, to be available only for Individual Learning Accounts:
      Provided, That such funds may be used for any individual full-time equivalent employee while such employee is employed either by CDC
      or ATSDR.SEC. [214]213.  Notwithstanding any other provisions of law, discretionary funds made available in this Act may be used to continue operating
      the Council on Graduate Medical Education established by section 301 of Public Law 102â408.SEC. [215]214.  Not to exceed $45,000,000 of funds appropriated by this Act to the institutes and centers of the National Institutes of Health
      may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the
      activities authorized herein, at not to exceed $3,500,000 per project.'
      			
      (transfer of funds)SEC. [216]215.  Of the amounts made available for NIH, 1 percent of the amount made available for National Research Service Awards ("NRSA'')
      shall be made available to the Administrator of the Health Resources and Services Administration to make NRSA awards for research
      in primary medical care to individuals affiliated with entities who have received grants or contracts under section 747 of
      the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of the Agency for
      Healthcare Research and Quality to make NRSA awards for health service research.[SEC. 217. Such portion as the Secretary shall determine, but not more than 1 percent, of any discretionary funds which are appropriated
      in this Act for the current fiscal year for domestic HIV/AIDS activities in any program, project, or activity carried out
      by the Department of Health and Human Services shall be made available to the Office of the Assistant Secretary for Health
      to support the National HIV/AIDS Strategy: Provided, That such support may be provided directly, or by grants or contracts, on a reimbursable basis.]SEC. [218]216. 
      (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.â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.â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.
         
      SEC. 217.  The Director of the CDC, or the Administrator of the Agency for Toxic Substances and Disease Registry, may detail staff without
            reimbursement for up to 180 days, to support the CDC response to a public health emergency or urgent public health event that
            involves activation of the Emergency Operations Center at the CDC. SEC. 218.  Funds provided to the National Institutes of Health in this and subsequent acts may be used to support the Sanctuary System
            for Surplus Chimpanzees authorized by section 404K of the Public Health Service Act, including for the construction, renovation,
            and funding of current or additional facilities of the sanctuary system as authorized by section 404K, notwithstanding the
            limitations in subsection (g) of such section. SEC. 219.  In the event of a public health emergency declared under section 319 of the PHS Act, the Secretary of HHS may, during the
            duration of the emergency, transfer discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act
            of 1985) which are appropriated in this Act for the current fiscal year for HHS between appropriations for costs of responding
            to and aiding in recovery from such public health emergency: Provided, That no appropriation may be reduced by more than 10
            percent under this section: Provided further, That the Committees on Appropriations of the House of Representatives and the
            Senate shall be promptly notified of such transfers: Provided further, That this transfer authority is in addition to any
            other transfer authority. SEC. 220.  Notwithstanding section 338E(c)(2) of the PHS Act, unless funds have been paid to or on behalf of an individual under section
            338B(g) of such Act, the Secretary or the individual with whom the Secretary entered into a contract under section 338B of
            such Act in this or any subsequent fiscal year may terminate the contract within 60 days of its execution.  The party electing
            to terminate the contract under such section must provide written notice to the other party prior to expiration of the 60-day
            period, and termination of the contract shall be effective upon verified receipt of the termination notice. SEC. 221.  Health Information Technology User Fees.â (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.â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.â(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.SEC. 222.  (a) The Biomedical Advanced Research and Development Authority (BARDA) may enter into a contract, for more than one but no
            more than ten program years, for purchase of research services or of security countermeasures, as that term is defined in
            section 319F-2(c)(1)(B) of the Public Health Service Act (42 U.S.C. 247d-6b(c)(1)(B)), ifâ 
         (1) funds are available and obligatedâ
         
            (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.
      
       (b) A contract entered into under this section:
       (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.