[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; [$4,346,670,000] $4,430,203,000: Provided, That of the amount provided under this heading, [$760,000,000] $798,000,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this account and
         remain available until expended; [$114,833,000] $128,282,000 shall be derived from medical device user fees authorized by 21 U.S.C. 379j, and shall be credited to this account and remain
         available until expended; [$305,996,000] $312,116,000 shall be derived from human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account
         and remain available until expended; [$20,716,000] $21,014,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall be credited to this
         account and remain available until expended; [$23,600,000] $22,464,000 shall be derived from animal drug user fees authorized by 21 U.S.C. 379j-12, and shall be credited to this account and remain
         available until expended; [$7,328,000] $6,944,000 shall be derived from animal generic drug user fees authorized by 21 U.S.C. 379j-21, and shall be credited to this account
         and remain available until expended; [$534,000,000] $566,000,000 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 21 U.S.C. 379j-31, and shall be credited to this
         account and remain available until expended; $15,367,000 shall be derived from food reinspection fees authorized by 21 U.S.C.
         379j-31, and shall be credited to this account and remain available until expended; and amounts derived from voluntary qualified
         importer program fees authorized by 21 U.S.C. 379j-31 shall be credited to this account and remain available until expended]: Provided further, That in addition and notwithstanding any other provision under this heading, amounts collected for prescription drug user
         fees, medical device user fees, human generic drug user fees, biosimilar biological product user fees, animal drug user fees,
         and animal generic drug user fees that exceed the respective fiscal year [2014] 2015 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device, human generic drug, biosimilar biological product, animal drug,
         and animal generic drug assessments for fiscal year [2014] 2015, including any such fees collected prior to fiscal year [2014] 2015 but credited for fiscal year [2014] 2015, shall be subject to the fiscal year [2014] 2015 limitations: Provided further, That the Secretary may accept payment during fiscal year [2014] 2015 of user fees specified under this heading and authorized for fiscal year [2015] 2016, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year [2015] 2016 for which the Secretary accepts payment in fiscal year [2014] 2015 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C.
         9701: [Provided further, That of the total amount appropriated: (1) $900,259,000 shall be for the Center for Food Safety and Applied Nutrition and
         related field activities in the Office of Regulatory Affairs; (2) $1,289,304,000 shall be for the Center for Drug Evaluation
         and Research and related field activities in the Office of Regulatory Affairs; (3) $337,543,000 shall be for the Center for
         Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $173,207,000 shall
         be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $408,918,000
         shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs;
         (6) $62,494,000 shall be for the National Center for Toxicological Research; (7) $501,476,000 shall be for the Center for
         Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $178,361,000 shall
         be for Rent and Related activities, of which $61,922,000 is for White Oak Consolidation, other than the amounts paid to the
         General Services Administration for rent; (9) not to exceed $219,907,000 shall be for payments to the General Services Administration
         for rent; and (10) $275,201,000 shall be for other activities, including the Office of the Commissioner of Food and Drugs,
         the Office of Foods and Veterinary Medicine, the Office of Medical and Tobacco Products, the Office of Global and Regulatory
         Policy, the Office of Operations, the Office of the Chief Scientist, and central services for these offices:] Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided for, as determined by
         the Commissioner: [Provided further, That any transfer of funds pursuant to section 770(n) of the Federal Food, Drug, and Cosmetic Act (21 U.S.C. 379dd(n)) shall
         only be from amounts made available under this heading for other activities:] Provided further, That funds may be transferred from one specified activity to another with the prior [approval] notification of the Committees on Appropriations of both Houses of Congress.
      
      In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381,
         [and] priority review user fees authorized by 21 U.S.C. 360n, food and feed recall fees, food reinspection fees, and voluntary qualified importer program fees authorized by 21 U.S.C.
            379j-31, outsourcing facility fees authorized by 21 U.S.C.379j-62, prescription drug wholesale distributer licensing and inspection
            fees authorized by 21 U.S.C. 353(e)(3), and third-party logistics provider licensing and inspection fees authorized by 21
            U.S.C. 360eee-3(c)(1), [may] 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, $8,788,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2014.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  1
                  1
               
               
                  
                  Receipts:
               
               
                  0220
                  Cooperative Research and Development Agreements, FDA
                  3
                  2
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  3
                  3
                  4
               
               
                  
                  Appropriations:
               
               
                  0500
                  Salaries and Expenses
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  1
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foods
                  797
                  883
                  903
               
               
                  0002
                  Drugs
                  438
                  466
                  480
               
               
                  0003
                  Devices and Radiological Products
                  296
                  321
                  318
               
               
                  0004
                  National Center for Toxicological Research
                  55
                  62
                  59
               
               
                  0005
                  Other Activities
                  160
                  172
                  175
               
               
                  0006
                  Other Rent and Rent Related Activities
                  118
                  132
                  116
               
               
                  0007
                  Rental Payments
                  150
                  162
                  169
               
               
                  0008
                  Buildings and Facilities
                  6
                  9
                  9
               
               
                  0009
                  CRADAs
                  2
                  2
                  2
               
               
                  0010
                  Animal Drugs and Feed
                  126
                  141
                  145
               
               
                  0011
                  Biologics
                  195
                  211
                  210
               
               
                  0012
                  Food and Drug Safety (no-year)
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  2,352
                  2,561
                  2,586
               
               
                  0801
                  Reimbursable program (User fees)
                  1,795
                  2,456
                  1,900
               
               
                  0802
                  Reimbursable program (Federal sources)
                  40
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,835
                  2,456
                  1,900
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  4,187
                  5,017
                  4,486
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  852
                  670
                  122
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  853
                  670
                  122
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,580
                  2,561
                  2,584
               
               
                  1130
                  Appropriations permanently reduced
                  â194
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,386
                  2,561
                  2,584
               
               
                  
                  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
                  1,676
                  1,827
                  1,900
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  23
                  
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  327
                  333
                  333
               
               
                  1702
                  Offsetting collections (previously unavailable) â previously reported as precluded from obligation that will be available
                     for obligation
                  
                  
                  79
                  
               
               
                  1723
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â67
                  
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â564
                  â333
                  â333
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,395
                  1,906
                  1,900
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  232
                  
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  221
                  
                  
               
               
                  1900
                  Budget authority (total)
                  4,004
                  4,469
                  4,486
               
               
                  1930
                  Total budgetary resources available
                  4,857
                  5,139
                  4,608
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  670
                  122
                  122
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,663
                  2,319
                  2,841
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4,187
                  5,017
                  4,486
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3,460
                  â4,495
                  â4,776
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â71
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,319
                  2,841
                  2,551
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â44
                  â51
                  â51
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â23
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â51
                  â51
                  â51
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,619
                  2,268
                  2,790
               
               
                  3200
                  Obligated balance, end of year
                  2,268
                  2,790
                  2,500
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,781
                  4,467
                  4,484
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,516
                  3,401
                  3,409
               
               
                  4011
                  Outlays from discretionary balances
                  906
                  1,092
                  1,365
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,422
                  4,493
                  4,774
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â33
                  â1
                  
               
               
                  4033
                  Non-Federal sources
                  â1,657
                  â1,826
                  â1,900
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,690
                  â1,827
                  â1,900
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â23
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  2,082
                  2,640
                  2,584
               
               
                  4080
                  Outlays, net (discretionary)
                  1,732
                  2,666
                  2,874
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  223
                  2
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  38
                  2
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â232
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  2,073
                  2,642
                  2,586
               
               
                  4190
                  Outlays, net (total)
                  1,538
                  2,668
                  2,876
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unavailable balance, SOY: Offsetting collections
                  349
                  664
                  585
               
               
                  5091
                  Unavailable balance, EOY: Offsetting collections
                  664
                  585
                  585
               
               
                  
                     
                  
               
            
         
      
      
         [In millions of dollars]
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2013
                     2014
                     2015
                  
                  
                     
                        
                     
                  
                  
                     Distribution of discretionary budget authority by account:
                     
                     
                     
                  
                  
                     Salaries and expenses
                     2,380
                     2,552
                     2,575
                  
                  
                     Buildings and facilities
                     6
                     9
                     9
                  
                  
                     Distribution of discretionary outlays by account:
                     
                     
                     
                  
                  
                     Salaries and expenses
                     1,726
                     2,657
                     2,865
                  
                  
                     Buildings and facilities
                     6
                     9
                     9
                  
                  
                     
                        
                     
                  
               
            
         
         The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and
            security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation.
            FDA also has responsbility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public
            health and to reduce tobacco use by minors. FDA advances public health by helping to speed innovations that make medicines
            more effective, safer, and more affordable and by helping the public get the accurate, science-based information they need
            to use medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by
            ensuring the security of the food supply and by fostering the development of medical products and countermeasures to respond
            to deliberate and naturally emerging public health threats. The FY 2015 Budget provides funding to support food and medical
            product safety, including implementation of the Food Safety Modernization Act and increased oversight of the pharmacy compounding
            industry, promote development of medical countermeasures, and maintain the integrity of operations and infrastructure.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  789
                  790
                  793
               
               
                  11.3
                  Other than full-time permanent
                  97
                  106
                  106
               
               
                  11.5
                  Other personnel compensation
                  46
                  56
                  56
               
               
                  11.7
                  Military personnel
                  62
                  61
                  61
               
               
                  11.8
                  Special personal services payments
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  995
                  1,014
                  1,017
               
               
                  12.1
                  Civilian personnel benefits
                  276
                  280
                  282
               
               
                  12.2
                  Military personnel benefits
                  32
                  32
                  32
               
               
                  21.0
                  Travel and transportation of persons
                  38
                  38
                  49
               
               
                  22.0
                  Transportation of things
                  3
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  150
                  162
                  169
               
               
                  23.2
                  Rental payments to others
                  5
                  3
                  3
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  38
                  38
                  40
               
               
                  24.0
                  Printing and reproduction
                  1
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  49
                  48
                  48
               
               
                  25.2
                  Other services from non-Federal sources
                  279
                  340
                  340
               
               
                  25.3
                  Other goods and services from Federal sources
                  143
                  233
                  233
               
               
                  25.4
                  Operation and maintenance of facilities
                  66
                  66
                  66
               
               
                  25.5
                  Research and development contracts
                  30
                  34
                  34
               
               
                  25.7
                  Operation and maintenance of equipment
                  63
                  50
                  50
               
               
                  26.0
                  Supplies and materials
                  33
                  44
                  44
               
               
                  31.0
                  Equipment
                  57
                  56
                  56
               
               
                  32.0
                  Land and structures
                  1
                  5
                  5
               
               
                  41.0
                  Grants, subsidies, and contributions
                  91
                  109
                  109
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,351
                  2,561
                  2,586
               
               
                  99.0
                  Reimbursable obligations
                  1,836
                  2,456
                  1,900
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  4,187
                  5,017
                  4,486
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â0â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  9,113
                  9,677
                  9,886
               
               
                  1101
                  Direct military average strength employment
                  684
                  648
                  648
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  3,960
                  5,117
                  5,441
               
               
                  2101
                  Reimbursable military average strength employment
                  297
                  343
                  343
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  48
                  48
                  48
               
               
                  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 user fees with respect to
            food facility registrations and inspections, food imports, food contact notification activities, 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Food Facility Registration and Inspection
                  
                  
                  60
               
               
                  0802
                  Food Import
                  
                  
                  169
               
               
                  0803
                  International Courier
                  
                  
                  6
               
               
                  0804
                  Cosmetics
                  
                  
                  19
               
               
                  0805
                  Food Contact Substance Notification
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  259
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  
                  259
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  
                  
                  259
               
               
                  1900
                  Budget authority (total)
                  
                  
                  259
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  259
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  259
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â259
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  259
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  259
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â259
               
               
                  
                     
                  
               
            
         
      
      
         The 2015 Budget includes a number of new user fees. Legislation will be proposed to allow FDA to collect fees for food import
            and food facility registration and inspection to implement the requirements of the FDA Food Safety Modernization Act (FSMA).
            The additional resources, estimated at $169 million for the food import program, would support FDA's food safety efforts to
            modernize the import system. The fees collected for the food facility registration and inspection program, estimated at $60
            million, would enable FDA to target new and improved activities required by FSMA to modernize the food safety system and support
            improvements in safety science and risk analysis to prevent food safety outbreaks. The Budget also reproposes user fees to
            support activities related to cosmetics and food contact notification activities, and fees to support inspection-related activities
            at domestic courier facilities.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  259
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9911â2â1â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  500
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other Services                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program
                  8
                  8
                  8
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  4
                  4
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  9
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  9
                  8
                  8
               
               
                  1930
                  Total budgetary resources available
                  12
                  12
                  12
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  4
                  4
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3
                  3
                  3
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  8
                  8
                  8
               
               
                  3020
                  Outlays (gross)
                  â8
                  â8
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3
                  3
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3
                  3
                  3
               
               
                  3200
                  Obligated balance, end of year
                  3
                  3
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  9
                  8
                  8
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  7
                  8
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8
                  8
                  9
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â9
                  â8
                  â8
               
               
                  4190
                  Outlays, net (total)
                  â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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  4
                  4
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  8
                  8
                  8
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4309â0â3â554
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  38
                  38
                  38
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services Administration                                                                             
            
         Federal Funds
         Health Resources and Services
         Primary Health CareFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act'') with respect
         to primary health care and the Native Hawaiian Health Care Act of 1988, [$1,495,276,000] $1,000,040,000: Provided, That no more than [$40,000] $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] $88,983,000 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:
         Provided further, That [of funds provided for the Health Centers program, as defined by section 330 of the PHS Act, by this Act or any other Act for
         fiscal year 2014, not less than $110,000,000 shall be obligated in fiscal year 2014 as base grant adjustments and not less
         than $350,000,000 shall be obligated in fiscal year 2014 to support new access points including approved and unfunded applications
         from fiscal year 2013, grants to expand medical services, behavioral health, oral health, pharmacy, and vision services, and
         costs associated with the HHS administration of these grants] funds made available for carrying out section 330 of the PHS Act in this or any prior Act, including section 10503 of Public
            Law 111â148, may also be used for the construction and improvement of community health centers.  
         Health WorkforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, section 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$734,236,000] $477,140,000: Provided, That $100,000,000, to remain available until expended, shall be for the National Health Service Corps Program: Provided further, That sections 747(c)(2)[, 751(j)(2),] and 762(k), and the proportional funding amounts in paragraphs (1) through (4) of section 756(e) of the PHS Act shall not apply
         to funds made available under this heading: Provided further, That [for any program operating under section 751 of the PHS Act on or before January 1, 2009, the Secretary may hereafter waive
         any of the requirements contained in sections 751(d)(2)(A) and 751(d)(2)(B) of such Act for the full project period of a grant
         under such section: Provided further, That no funds shall be available for section 340G-1 of the PHS Act: Provided further, That in addition to fees authorized by section 427(b) of the Health Care Quality Improvement Act of 1986, fees shall be
         collected for the full disclosure of information under such Act sufficient to recover the full costs of operating the National
         Practitioner Data Bank and shall remain available until expended to carry out that Act: Provided further, That fees collected for the full disclosure of information under the "Health Care Fraud and Abuse Data Collection Program'',
         authorized by section 1128E(d)(2) of the Social Security Act, shall be sufficient to recover the full costs of operating the
         program, and shall remain available until expended to carry out that Act: Provided further, That fees collected for the disclosure of information under the information reporting requirement program authorized by
         section 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the program and shall remain
         available until expended to carry out that Act:] fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of 1986 and
            sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating the programs
            authorized by such sections and shall remain available until expended for the National Practitioner Data Bank: 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, on April 1, 2015, available amounts appropriated under section 340H(g) of the PHS Act are hereby
            permanently cancelled, and an equal amount of funding is hereby appropriated to be available until expended to carry out such
            section: Provided further, That in addition to amounts provided herein, $61,581,000 shall be available from amounts available
            under section 241 of the PHS Act to carry out section 811 of the PHS Act.  
         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, [$846,017,000] $846,017,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $77,093,000 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, [$2,293,781,000],$2,297,781,000: of which [$1,970,881,000] $1,970,881,000 shall remain available to the Secretary through September 30, [2016] 2017, for parts A and B of title XXVI of the PHS Act, and of which not less than [$900,313,000] $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That in addition to amounts provided herein, [$25,000,000] $25,000,000 shall be available from amounts available under section 241 of the PHS  Act to carry out parts A, B, and C[, and D] of title XXVI of [the PHS] such 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, [$103,193,000] $103,659,000, of which [$122,000] $122,000 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 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 of 1969, [the Cardiac Arrest Survival Act of 2000,] and sections 711 and 1820 of the Social Security Act, [$142,335,000] $124,562,000, of which [$40,609,000] $26,200,000 from general revenues, notwithstanding section 1820(j) of the Social Security Act, shall be available for carrying out the
         Medicare rural hospital flexibility grants program: Provided, That of the funds made available under this heading for Medicare rural hospital flexibility grants, [$14,942,000 shall be available for the Small Rural Hospital Improvement Grant Program for quality improvement and adoption
         of health information technology and] up to [$1,000,000] $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, [$9,511,000] $9,511,000 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, [$286,479,000] $286,479,000: 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, [$153,061,000] $157,061,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings
         "Primary Health Care'', "Health Workforce'', "Maternal and Child Health'', "Ryan White HIV/AIDS Program'', "Health Care Systems'',
         and "Rural Health'': Provided further, That the Administrator may transfer funds between any of the accounts of HRSA with notification to the
            Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall
            be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0009
                  Free Clinics Medical Malpractice
                  1
                  
                  
               
               
                  0010
                  Health Centers
                  1,390
                  1,400
                  911
               
               
                  0012
                  National Health Service Corps
                  
                  
                  100
               
               
                  0013
                  Hansen's Disease Center
                  15
                  15
                  15
               
               
                  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
                  78
                  80
                  80
               
               
                  0017
                  Health Professions
                  357
                  389
                  297
               
               
                  0018
                  Maternal and Child Health Block Grant
                  605
                  634
                  634
               
               
                  0019
                  Healthy Start
                  98
                  101
                  101
               
               
                  0020
                  Poison Control Centers
                  18
                  19
                  19
               
               
                  0021
                  EMS for Children
                  20
                  20
                  20
               
               
                  0022
                  Universal Newborn Hearing Screening
                  18
                  18
                  18
               
               
                  0023
                  HIV/AIDS
                  2,220
                  2,297
                  2,298
               
               
                  0024
                  Organ Transplantation
                  23
                  24
                  24
               
               
                  0025
                  Bone Marrow Donor Registry
                  22
                  22
                  22
               
               
                  0026
                  Rural Health Policy Development
                  9
                  9
                  9
               
               
                  0027
                  Rural Health Outreach Grants
                  52
                  57
                  57
               
               
                  0028
                  Rural Health Flexibility Grants
                  38
                  41
                  26
               
               
                  0030
                  Telehealth
                  11
                  14
                  14
               
               
                  0031
                  Program Management
                  151
                  153
                  157
               
               
                  0032
                  Family Planning
                  278
                  286
                  286
               
               
                  0033
                  Loan Repayment/Faculty Fellowship
                  1
                  1
                  1
               
               
                  0035
                  Health Centers Tort Claim Fund
                  58
                  95
                  89
               
               
                  0036
                  Heritable Disorders
                  9
                  12
                  12
               
               
                  0038
                  Childrens' GME
                  251
                  265
                  
               
               
                  0041
                  State Offices of Rural Health
                  9
                  10
                  10
               
               
                  0043
                  Radiogenic Diseases
                  2
                  2
                  2
               
               
                  0044
                  Traumatic Brain Injury
                  9
                  9
                  9
               
               
                  0045
                  Autism and Other Developmental Disorders
                  45
                  47
                  47
               
               
                  0046
                  Cord Blood Stem Cell Bank
                  11
                  11
                  11
               
               
                  0048
                  Sickle Cell
                  4
                  4
                  4
               
               
                  0049
                  Drug Pricing Program
                  4
                  10
                  10
               
               
                  0050
                  Family to Family Health Information Centers ACA
                  5
                  3
                  
               
               
                  0067
                  Prevention Fund
                  2
                  
                  
               
               
                  0073
                  Health Centers ACA
                  1,491
                  2,145
                  3,600
               
               
                  0074
                  Health Centers Construction ACA
                  1
                  28
                  
               
               
                  0075
                  National Health Service Corps ACA
                  286
                  283
                  310
               
               
                  0076
                  School Based Health Centers ACA
                  82
                  2
                  2
               
               
                  0077
                  GME Payments THC ACA
                  31
                  73
                  105
               
               
                  0079
                  Rural Health AED
                  2
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  7,716
                  8,591
                  9,309
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  7,716
                  8,591
                  9,309
               
               
                  0801
                  Reimbursable program
                  48
                  48
                  54
               
               
                  0802
                  Reimbursable program: PHS evaluation
                  22
                  25
                  87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  70
                  73
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  7,786
                  8,664
                  9,450
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  382
                  362
                  261
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  68
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  414
                  362
                  261
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  6,194
                  6,054
                  5,293
               
               
                  1100
                  Appropriation
                  
                  
                  135
               
               
                  1120
                  Appropriations transferred to other accts [75â0943]
                  â16
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â1362]
                  â15
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0943]
                  8
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1362]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1502]
                  6
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0142]
                  1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â324
                  
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  
                  
                  â135
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,855
                  6,054
                  5,293
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,855
                  2,508
                  3,910
               
               
                  1221
                  Appropriations transferred from other accts [75â0116]
                  2
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â53
                  â77
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,804
                  2,431
                  3,910
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  31
                  62
                  122
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  31
                  
                  
               
               
                  1723
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  61
                  62
                  122
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Offsetting collections (cash)(HPSL&NSL)
                  16
                  16
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  16
                  16
                  16
               
               
                  1900
                  Budget authority (total)
                  7,736
                  8,563
                  9,341
               
               
                  1930
                  Total budgetary resources available
                  8,150
                  8,925
                  9,602
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  362
                  261
                  152
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,681
                  6,238
                  6,334
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7,786
                  8,664
                  9,450
               
               
                  3011
                  Obligations incurred, expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â8,136
                  â8,568
                  â8,770
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â32
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â64
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,238
                  6,334
                  7,014
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â80
                  â74
                  â74
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â74
                  â74
                  â74
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,601
                  6,164
                  6,260
               
               
                  3200
                  Obligated balance, end of year
                  6,164
                  6,260
                  6,940
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,916
                  6,116
                  5,415
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,201
                  2,407
                  2,075
               
               
                  4011
                  Outlays from discretionary balances
                  3,820
                  3,615
                  3,511
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  6,021
                  6,022
                  5,586
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â34
                  â35
                  â96
               
               
                  4033
                  Non-Federal sources
                  â30
                  â27
                  â19
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â64
                  â62
                  â122
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â31
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  5,854
                  6,054
                  5,293
               
               
                  4080
                  Outlays, net (discretionary)
                  5,957
                  5,960
                  5,464
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,820
                  2,447
                  3,926
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  907
                  1,166
                  1,467
               
               
                  4101
                  Outlays from mandatory balances
                  1,208
                  1,380
                  1,717
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,115
                  2,546
                  3,184
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â16
                  â16
                  â16
               
               
                  4180
                  Budget authority, net (total)
                  7,658
                  8,485
                  9,203
               
               
                  4190
                  Outlays, net (total)
                  8,056
                  8,490
                  8,632
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unavailable balance, SOY: Offsetting collections
                  
                  1
                  1
               
               
                  5091
                  Unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  7,658
                  8,485
                  9,203
               
               
                  
                  Outlays
                  8,056
                  8,490
                  8,632
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  400
               
               
                  
                  Outlays
                  
                  
                  200
               
               
                  Total:
               
               
                  
                  Budget Authority
                  7,658
                  8,485
                  9,603
               
               
                  
                  Outlays
                  8,056
                  8,490
                  8,832
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Guaranteed loan levels supportable by subsidy budget authority:
               
               
                  215001
                  Health centers: Facilities renovation loan guarantee levels
                  
                  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
                  
                  12
                  6
               
               
                  
                  Guaranteed loan subsidy (in percent):
               
               
                  232001
                  Health centers: Facilities renovation loan guarantee levels
                  0.00
                  2.81
                  2.67
               
               
                  232002
                  Health centers: Managed care network development loan guarantee
                  0.00
                  10.10
                  9.68
               
               
                  232003
                  Health centers: Managed care plan loan guarantee levels
                  0.00
                  5.86
                  5.83
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  232999
                  Weighted average subsidy rate
                  0.00
                  4.18
                  4.37
               
               
                  
                     
                  
               
            
         
      
      
         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 2015 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 program's 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 2012â2013 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     389,796,286
                  
                  
                     NSL
                     174,462,796
                  
                  
                     PCL
                     258,568,607
                  
                  
                     LDS
                     132,944,663
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     955,772,352
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  157
                  166
                  160
               
               
                  11.3
                  Other than full-time permanent
                  6
                  6
                  6
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  19
                  19
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  184
                  193
                  187
               
               
                  12.1
                  Civilian personnel benefits
                  47
                  50
                  49
               
               
                  12.2
                  Military personnel benefits
                  10
                  10
                  10
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  21
                  22
                  26
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  6
                  6
                  6
               
               
                  25.1
                  Advisory and assistance services
                  13
                  13
                  13
               
               
                  25.2
                  Other services from non-Federal sources
                  137
                  133
                  127
               
               
                  25.3
                  Other goods and services from Federal sources
                  200
                  196
                  183
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.6
                  Medical care
                  3
                  3
                  2
               
               
                  25.7
                  Operation and maintenance of equipment
                  25
                  25
                  23
               
               
                  26.0
                  Supplies and materials
                  2
                  2
                  2
               
               
                  31.0
                  Equipment
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  7,010
                  7,880
                  8,623
               
               
                  42.0
                  Insurance claims and indemnities
                  51
                  51
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  7,716
                  8,591
                  9,309
               
               
                  99.0
                  Reimbursable obligations
                  70
                  73
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  7,786
                  8,664
                  9,450
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,578
                  1,613
                  1,596
               
               
                  1101
                  Direct military average strength employment
                  195
                  195
                  195
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  62
                  62
                  72
               
               
                  2101
                  Reimbursable military average strength employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0075
                  National Health Service Corps ACA
                  
                  
                  400
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  
                  
                  400
               
               
                  0803
                  Reimbursable program:  Targeted Support for GME
                  
                  
                  530
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  930
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  400
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  400
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  530
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  
                  
                  530
               
               
                  1900
                  Budget authority (total)
                  
                  
                  930
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  930
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  930
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â730
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  200
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  200
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  930
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  730
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â530
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  400
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  200
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  
                  3
               
               
                  11.7
                  Military personnel
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  23
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  362
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  399
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  531
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  930
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0350â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  56
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  5
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  
               
               
                  2101
                  Reimbursable military average strength employment
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury Compensation                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0320â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  15
                  19
                  19
               
               
                  
                  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
                  19
                  19
                  19
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  19
                  19
                  19
               
               
                  
                     
                  
               
               
                  
                  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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Claims
                  3
                  1
                  1
               
               
                  0103
                  Admin Expense
                  
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  3
                  4
                  4
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  2
                  1
               
               
                  1011
                  Unobligated balance transfer from other accts [75â0140]
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  5
                  5
                  4
               
               
                  1930
                  Total budgetary resources available
                  5
                  5
                  4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  2
                  6
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  3
                  4
                  4
               
               
                  3020
                  Outlays (gross)
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2
                  6
                  10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  2
                  6
               
               
                  3200
                  Obligated balance, end of year
                  2
                  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
            319F-3(b) of the Public Health Service Act. Additionally, authority is provided to address any unexpected claims that may
            arise under the Smallpox Emergency Personal Protection Act of 2003.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  2
                  2
                  2
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3
                  3
                  3
               
               
                  99.5
                  Below reporting threshold
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  3
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0343â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  5
                  5
               
               
                  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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0010
                  Maternal, Infant, and Early Childhood Home Visiting Programs
                  378
                  396
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  14
                  25
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  23
                  25
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  400
                  400
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â20
                  â29
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  380
                  371
                  
               
               
                  1930
                  Total budgetary resources available
                  403
                  396
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  25
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  528
                  654
                  734
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  378
                  396
                  
               
               
                  3020
                  Outlays (gross)
                  â242
                  â316
                  â348
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  654
                  734
                  386
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  528
                  654
                  734
               
               
                  3200
                  Obligated balance, end of year
                  654
                  734
                  386
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  380
                  371
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  12
                  15
                  
               
               
                  4101
                  Outlays from mandatory balances
                  230
                  301
                  348
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  242
                  316
                  348
               
               
                  4180
                  Budget authority, net (total)
                  380
                  371
                  
               
               
                  4190
                  Outlays, net (total)
                  242
                  316
                  348
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  380
                  371
                  
               
               
                  
                  Outlays
                  242
                  316
                  348
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  500
               
               
                  
                  Outlays
                  
                  
                  20
               
               
                  Total:
               
               
                  
                  Budget Authority
                  380
                  371
                  500
               
               
                  
                  Outlays
                  242
                  316
                  368
               
               
                  
                     
                  
               
            
         
      
      
         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.  The 2015 Budget includes $500 million for the Maternal, Infant and Early Childhood Home
            Visiting Program to extend and expand evidenced-based home visiting services for at risk communities. These activities are
            administered by HRSA.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  2
                  2
                  
               
               
                  11.7
                  Military personnel
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  2
                  3
                  
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  19
                  19
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  356
                  373
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  378
                  396
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  19
                  19
                  
               
               
                  1101
                  Direct military average strength employment
                  3
                  3
                  
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0010
                  Maternal, Infant, and Early Childhood Home Visiting Programs
                  
                  
                  497
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  
                  
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  
                  
                  25
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  500
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  500
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  525
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  497
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  477
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  477
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  500
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  20
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  500
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  20
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  
                  3
               
               
                  11.7
                  Military personnel
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  23
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  469
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  497
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0321â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  19
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing Account                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4442â0â3â551
                  2013 actual
                  2014 est.
                  2015 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on commitments:
               
               
                  2121
                  Limitation available from carry-forward
                  18
                  18
                  6
               
               
                  2143
                  Uncommitted limitation carried forward
                  â18
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2150
                  Total guaranteed loan commitments
                  
                  12
                  6
               
               
                  2199
                  Guaranteed amount of guaranteed loan commitments
                  
                  12
                  6
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of guaranteed loans outstanding:
               
               
                  2210
                  Outstanding, start of year
                  77
                  77
                  78
               
               
                  2231
                  Disbursements of new guaranteed loans
                  
                  12
                  6
               
               
                  2251
                  Repayments and prepayments
                  
                  â10
                  â10
               
               
                  2263
                  Adjustments: Terminations for default that result in claim payments
                  
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  77
                  78
                  73
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  77
                  60
                  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
                  2012 actual
                  2013 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 Account[Such sums as may be necessary to carry out the purpose of the program, as authorized by title VII of the PHS Act. For administrative
         expenses to carry out the guaranteed loan program, including section 709 of the PHS Act, $2,687,000.] (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2013 actual
                  2014 est.
                  2015 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
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  59
                  2
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3
                  3
                  
               
               
                  1120
                  Appropriations transferred to other accts [91â0202]
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3
                  2
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  56
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  56
                  
                  
               
               
                  1900
                  Budget authority (total)
                  59
                  2
                  
               
               
                  1930
                  Total budgetary resources available
                  59
                  2
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1
                  1
                  1
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  59
                  2
                  
               
               
                  3020
                  Outlays (gross)
                  â59
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  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
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3
                  2
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  3
                  2
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  56
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  56
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  59
                  2
                  
               
               
                  4190
                  Outlays, net (total)
                  59
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2013 actual
                  2014 est.
                  2015 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43
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  237999
                  Total downward reestimate subsidy budget authority
                  
                  â43
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3510
                  Budget authority
                  3
                  
                  
               
               
                  3590
                  Outlays from new authority
                  2
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
          Pursuant to P.L. 113â76, the Consolidated Appropriations Act, 2014 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 are permanently
            transferred to the Secretary of Education.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  1
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  56
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  59
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0340â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  14
                  14
                  
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Financing Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0711
                  Default claim payments on principal
                  10
                  12
                  
               
               
                  0742
                  Downward reestimate paid to receipt account
                  
                  18
                  
               
               
                  0743
                  Interest on downward reestimates
                  
                  26
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  10
                  56
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  49
                  107
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [91â4300]
                  
                  â54
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  48
                  53
                  
               
               
                  
                  Financing authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  69
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  69
                  3
                  
               
               
                  1930
                  Total budgetary resources available
                  117
                  56
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  107
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  10
                  56
                  
               
               
                  3020
                  Financing disbursements (gross)
                  â10
                  â56
                  
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Financing authority, gross
                  69
                  3
                  
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Financing disbursements, gross
                  10
                  56
                  
               
               
                  
                  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6
                  
                  
               
               
                  4123
                  Recoveries of defaulted loans
                  â7
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross financing auth and disbursements (total)
                  â69
                  â3
                  
               
               
                  4170
                  Financing disbursements, net (mandatory)
                  â59
                  53
                  
               
               
                  4190
                  Financing disbursements, net (total)
                  â59
                  53
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of guaranteed loans outstanding:
               
               
                  2210
                  Outstanding, start of year
                  430
                  350
                  
               
               
                  2251
                  Repayments and prepayments
                  â70
                  â5
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â8
                  â13
                  
               
               
                  2263
                  Terminations for default that result in claim payments
                  â2
                  â3
                  
               
               
                  2264
                  Other adjustments, net
                  
                  â329
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  350
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  350
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Addendum:
               
               
                  
                  Cumulative balance of defaulted guaranteed loans that result in loans receivable:
               
               
                  2310
                  Outstanding, start of year
                  184
                  192
                  
               
               
                  2331
                  Disbursements for guaranteed loan claims
                  10
                  12
                  
               
               
                  2361
                  Write-offs of loans receivable
                  â2
                  â3
                  
               
               
                  2364
                  Other adjustments, net
                  
                  â201
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  192
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         Pursuant to P.L. 113â76, the Consolidated Appropriations Act, 2014 this activity is transferred to the Department of Education.
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4304â0â3â552
                  2012 actual
                  2013 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  50
                  108
               
               
                  
                  Net value of assets related to post-1991 acquired defaulted guaranteed loans receivable:
               
               
                  1501
                  Defaulted guaranteed loans receivable, gross
                  184
                  192
               
               
                  1505
                  Allowance for subsidy cost (-)
                  â126
                  â144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1599
                  Net present value of assets related to defaulted guaranteed loans
                  58
                  48
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  108
                  156
               
               
                  
                  LIABILITIES:
               
               
                  2204
                  Non-Federal liabilities: Liabilities for loan guarantees
                  108
                  156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  108
                  156
               
               
                  
                     
                  
               
            
         
      
         Health Education Assistance Loans Liquidating Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0711
                  Default claim payments on principal
                  2
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 33.0)
                  2
                  2
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1
                  1
                  
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  9
                  9
                  
               
               
                  1820
                  Capital transfer of spending authority from offsetting collections to general fund
                  â8
                  â8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1
                  1
                  
               
               
                  1900
                  Budget authority (total)
                  2
                  2
                  
               
               
                  1930
                  Total budgetary resources available
                  2
                  2
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2
                  2
                  
               
               
                  3020
                  Outlays (gross)
                  â2
                  â2
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  2
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  2
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â9
                  â9
                  
               
               
                  4180
                  Budget authority, net (total)
                  â7
                  â7
                  
               
               
                  4190
                  Outlays, net (total)
                  â7
                  â7
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of guaranteed loans outstanding:
               
               
                  2210
                  Outstanding, start of year
                  64
                  49
                  
               
               
                  2251
                  Repayments and prepayments
                  â13
                  â7
                  
               
               
                  
                  Adjustments:
               
               
                  2261
                  Terminations for default that result in loans receivable
                  â2
                  â2
                  
               
               
                  2264
                  Other adjustments, net
                  
                  â40
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  49
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  49
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Addendum:
               
               
                  
                  Cumulative balance of defaulted guaranteed loans that result in loans receivable:
               
               
                  2310
                  Outstanding, start of year
                  346
                  331
                  
               
               
                  2331
                  Disbursements for guaranteed loan claims
                  2
                  2
                  
               
               
                  2351
                  Repayments of loans receivable
                  â8
                  â9
                  
               
               
                  2361
                  Write-offs of loans receivable
                  â20
                  
                  
               
               
                  2364
                  Other adjustments, net
                  11
                  â324
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2390
                  Outstanding, end of year
                  331
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         Pursuant to P.L. 113â76, the Consolidated Appropriations Act, 2014 this activity is transferred to the Department of Education.
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4305â0â3â552
                  2012 actual
                  2013 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  1
                  1
               
               
                  1701
                  Defaulted guaranteed loans, gross
                  346
                  331
               
               
                  1703
                  Allowance for estimated uncollectible loans and interest (-)
                  â238
                  â248
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1799
                  Value of assets related to loan guarantees
                  108
                  83
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  109
                  84
               
               
                  
                  LIABILITIES:
               
               
                  2104
                  Federal liabilities: Resources payable to Treasury
                  109
                  82
               
               
                  2204
                  Non-Federal liabilities: Liabilities for loan guarantees
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total liabilities
                  109
                  84
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  109
                  84
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan Fund                                                                               
            
         Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9931â0â3â551
                  2013 actual
                  2014 est.
                  2015 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
                  2012 actual
                  2013 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 (the "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 [$6,464,000] $7,500,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2014.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  3,214
                  3,244
                  3,304
               
               
                  
                  Receipts:
               
               
                  0200
                  Deposits, Vaccine Injury Compensation Trust Fund
                  204
                  249
                  256
               
               
                  0240
                  Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                  119
                  115
                  128
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0299
                  Total receipts and collections
                  323
                  364
                  384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  3,537
                  3,608
                  3,688
               
               
                  
                  Appropriations:
               
               
                  0500
                  Vaccine Injury Compensation Program Trust Fund
                  â18
                  â19
                  â21
               
               
                  0501
                  Vaccine Injury Compensation Program Trust Fund
                  â275
                  â285
                  â293
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â293
                  â304
                  â314
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  3,244
                  3,304
                  3,374
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Compensation: Claims for post - FY 1989 injuries
                  275
                  285
                  293
               
               
                  0103
                  Claims processing (Claims Court)
                  5
                  5
                  5
               
               
                  0104
                  Claims processing (HRSA)
                  6
                  6
                  8
               
               
                  0105
                  Claims processing (Dept. of Justice)
                  8
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total, administrative expenses
                  19
                  19
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  294
                  304
                  314
               
               
                  0801
                  Reimbursable program activity (claims)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  296
                  304
                  314
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  18
                  19
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  18
                  19
                  21
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  275
                  285
                  293
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  275
                  285
                  293
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  2
                  
                  
               
               
                  1900
                  Budget authority (total)
                  295
                  304
                  314
               
               
                  1930
                  Total budgetary resources available
                  296
                  304
                  314
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  19
                  16
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  296
                  304
                  314
               
               
                  3020
                  Outlays (gross)
                  â298
                  â320
                  â314
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  16
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  19
                  16
                  
               
               
                  3200
                  Obligated balance, end of year
                  16
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  18
                  19
                  21
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  13
                  19
                  21
               
               
                  4011
                  Outlays from discretionary balances
                  8
                  16
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  21
                  35
                  21
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  277
                  285
                  293
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  277
                  285
                  293
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  293
                  304
                  314
               
               
                  4190
                  Outlays, net (total)
                  296
                  320
                  314
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  3,194
                  3,244
                  3,324
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  3,244
                  3,324
                  3,415
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  2
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  3
                  16
                  18
               
               
                  42.0
                  Insurance claims and indemnities
                  290
                  285
                  293
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  296
                  304
                  314
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8175â0â7â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  17
                  20
                  23
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Indian Health Service                                                                                                    
            
         Federal Funds
         Indian Health ServicesFor expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education Assistance 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, [$3,982,842,000] $4,172,182,000, 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,[$878,575,000] $929,041,000 for Purchased/Referred Care, including [$51,500,000] $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: 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 the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating
         health facilities pursuant to Public Law 93â638, such individually identifiable health information relating to disabled children
         as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
         U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
         Indian Health Facilities account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Clinical services
                  3,051
                  3,099
                  3,243
               
               
                  0002
                  Preventive health
                  143
                  148
                  156
               
               
                  0003
                  Urban health
                  41
                  41
                  41
               
               
                  0004
                  Indian health professions
                  32
                  34
                  39
               
               
                  0005
                  Tribal management
                  2
                  1
                  2
               
               
                  0006
                  Direct operations
                  68
                  68
                  68
               
               
                  0007
                  Self-governance
                  6
                  5
                  6
               
               
                  0008
                  Contract support costs
                  448
                  587
                  617
               
               
                  0009
                  Diabetes funds
                  147
                  147
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,938
                  4,130
                  4,172
               
               
                  0801
                  Reimbursable program
                  1,219
                  1,334
                  1,364
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  5,157
                  5,464
                  5,536
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  560
                  577
                  408
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  560
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  124
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  684
                  577
                  408
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,915
                  3,983
                  4,172
               
               
                  1120
                  Appropriations transferred to other accts [75â0390]
                  â65
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0390]
                  65
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â202
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,713
                  3,983
                  4,172
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  150
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  147
                  147
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,203
                  1,165
                  1,165
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,193
                  1,165
                  1,165
               
               
                  1900
                  Budget authority (total)
                  5,053
                  5,295
                  5,337
               
               
                  1930
                  Total budgetary resources available
                  5,737
                  5,872
                  5,745
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  577
                  408
                  209
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  844
                  833
                  1,016
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  5,157
                  5,464
                  5,536
               
               
                  3011
                  Obligations incurred, expired accounts
                  24
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,037
                  â5,281
                  â5,416
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â124
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  833
                  1,016
                  1,136
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â82
                  â68
                  â68
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â68
                  â68
                  â68
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  762
                  765
                  948
               
               
                  3200
                  Obligated balance, end of year
                  765
                  948
                  1,068
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,906
                  5,148
                  5,337
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,178
                  4,431
                  4,586
               
               
                  4011
                  Outlays from discretionary balances
                  734
                  838
                  830
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,912
                  5,269
                  5,416
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â263
                  â368
                  â368
               
               
                  4033
                  Non-Federal sources
                  â942
                  â797
                  â797
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,205
                  â1,165
                  â1,165
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  10
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,713
                  3,983
                  4,172
               
               
                  4080
                  Outlays, net (discretionary)
                  3,707
                  4,104
                  4,251
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  147
                  147
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  48
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  77
                  12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  125
                  12
                  
               
               
                  4180
                  Budget authority, net (total)
                  3,860
                  4,130
                  4,172
               
               
                  4190
                  Outlays, net (total)
                  3,832
                  4,116
                  4,251
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  3,860
                  4,130
                  4,172
               
               
                  
                  Outlays
                  3,832
                  4,116
                  4,251
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  150
               
               
                  
                  Outlays
                  
                  
                  144
               
               
                  Total:
               
               
                  
                  Budget Authority
                  3,860
                  4,130
                  4,322
               
               
                  
                  Outlays
                  3,832
                  4,116
                  4,395
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Services account provides medical care, public health services, and health professions training opportunities
            to American Indians and Alaska Natives. An estimated $2.248 billion primarily through self-determination contracts and compacts,
            will be administered by tribal governments in 2015.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  397
                  404
                  413
               
               
                  11.3
                  Other than full-time permanent
                  20
                  20
                  21
               
               
                  11.5
                  Other personnel compensation
                  50
                  51
                  52
               
               
                  11.7
                  Military personnel
                  72
                  74
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  539
                  549
                  561
               
               
                  12.1
                  Civilian personnel benefits
                  143
                  146
                  149
               
               
                  12.2
                  Military personnel benefits
                  32
                  32
                  33
               
               
                  13.0
                  Benefits for former personnel
                  13
                  13
                  13
               
               
                  21.0
                  Travel and transportation of persons
                  8
                  8
                  8
               
               
                  21.0
                  Patient travel
                  32
                  33
                  35
               
               
                  22.0
                  Transportation of things
                  6
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  8
                  8
                  8
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  11
                  11
                  11
               
               
                  25.1
                  Advisory and assistance services
                  8
                  8
                  8
               
               
                  25.2
                  Other services from non-Federal sources
                  90
                  95
                  101
               
               
                  25.3
                  Other goods and services from Federal sources
                  50
                  51
                  52
               
               
                  25.4
                  Operation and maintenance of facilities
                  8
                  9
                  9
               
               
                  25.6
                  Medical care
                  308
                  452
                  504
               
               
                  25.7
                  Operation and maintenance of equipment
                  13
                  13
                  13
               
               
                  25.8
                  Subsistence and support of persons
                  3
                  3
                  3
               
               
                  26.0
                  Supplies and materials
                  98
                  103
                  109
               
               
                  31.0
                  Equipment
                  7
                  8
                  8
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,559
                  2,580
                  2,539
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,938
                  4,130
                  4,172
               
               
                  99.0
                  Reimbursable obligations
                  1,219
                  1,334
                  1,364
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  5,157
                  5,464
                  5,536
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  7,082
                  7,358
                  7,474
               
               
                  1101
                  Direct military average strength employment
                  1,105
                  1,138
                  1,147
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  5,173
                  5,059
                  5,065
               
               
                  2101
                  Reimbursable military average strength employment
                  807
                  783
                  777
               
               
                  
                     
                  
               
            
         
      
         Indian Health Services                                                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0390â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0003
                  Urban health
                  
                  
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  150
               
               
                  1900
                  Budget authority (total)
                  
                  
                  150
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  150
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  6
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  144
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  144
               
               
                  
                     
                  
               
            
         
      
         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, $461,995,000 [$451,673,000], 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 may 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 may 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 may be placed in a Demolition Fund, to remain available until expended, and be used by the Indian
         Health Service for the demolition of Federal buildings. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â551
                  2013 actual
                  2014 est.
                  2015 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Sanitation and health facilities
                  164
                  164
                  164
               
               
                  0002
                  Maintenance
                  54
                  54
                  54
               
               
                  0003
                  Facilities and environmental health
                  201
                  211
                  221
               
               
                  0004
                  Equipment
                  20
                  23
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  439
                  452
                  462
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  439
                  452
                  462
               
               
                  0801
                  Reimbursable program
                  65
                  65
                  65
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  504
                  517
                  527
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  169
                  156
                  105
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  169
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  177
                  156
                  105
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  442
                  452
                  462
               
               
                  1130
                  Appropriations permanently reduced
                  â23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  419
                  452
                  462
               
               
                  
                  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
                  56
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  56
                  6
                  6
               
               
                  1900
                  Budget authority (total)
                  483
                  466
                  476
               
               
                  1930
                  Total budgetary resources available
                  660
                  622
                  581
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  156
                  105
                  54
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  525
                  522
                  542
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  504
                  517
                  527
               
               
                  3020
                  Outlays (gross)
                  â498
                  â497
                  â494
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  522
                  542
                  575
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â5
                  â5
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5
                  â5
                  â5
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  519
                  517
                  537
               
               
                  3200
                  Obligated balance, end of year
                  517
                  537
                  570
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  475
                  458
                  468
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  259
                  142
                  145
               
               
                  4011
                  Outlays from discretionary balances
                  230
                  347
                  341
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  489
                  489
                  486
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â42
                  â6
                  â6
               
               
                  4033
                  Non-Federal sources
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â56
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  419
                  452
                  462
               
               
                  4080
                  Outlays, net (discretionary)
                  433
                  483
                  480
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8
                  8
                  8
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  8
                  8
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  9
                  8
                  8
               
               
                  4180
                  Budget authority, net (total)
                  427
                  460
                  470
               
               
                  4190
                  Outlays, net (total)
                  442
                  491
                  488
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
            facilities support for the Indian Health Service. An estimated $208.7 million primarily through self-determination contracts
            and compacts, will be administered by tribal governments in 2015.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  46
                  48
                  51
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  24
                  24
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  74
                  76
                  80
               
               
                  12.1
                  Civilian personnel benefits
                  14
                  15
                  16
               
               
                  12.2
                  Military personnel benefits
                  9
                  9
                  9
               
               
                  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
                  14
                  16
                  16
               
               
                  25.1
                  Advisory and assistance services
                  3
                  2
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  69
                  71
                  71
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  25.4
                  Operation and maintenance of facilities
                  9
                  10
                  10
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  6
                  6
               
               
                  26.0
                  Supplies and materials
                  6
                  7
                  7
               
               
                  31.0
                  Equipment
                  8
                  9
                  10
               
               
                  32.0
                  Land and structures
                  83
                  82
                  82
               
               
                  41.0
                  Grants, subsidies, and contributions
                  136
                  140
                  144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  439
                  452
                  462
               
               
                  99.0
                  Reimbursable obligations
                  65
                  65
                  65
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  504
                  517
                  527
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0391â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,003
                  1,049
                  1,082
               
               
                  1101
                  Direct military average strength employment
                  171
                  171
                  163
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  29
                  29
                  29
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONS                                                                                                
            
         
         Indian Health Service Administrative ProvisionsAppropriations 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 notified to 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, 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, [$571,536,000] $607,942,000: Provided, That in addition to amounts provided herein, $12,864,000 shall be available from amounts available under section 241 of
         the PHS Act to carry out the National Immunization Surveys.  
         Hiv/Aids, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis PreventionFor carrying out titles II, III, XVII, and XXIII[, and XXVI] of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention, [$1,072,834,000] $1,124,942,000: 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, 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, [$287,300,000] $393,549,000: Provided, That of the [funds provided for the Advanced Molecular Detection initiative, the CDC Director shall establish and publish a five-year program
         implementation plan within 90 days of enactment] amounts available to pay for the transportation, medical care, treatment, and other related costs of persons quarantined
            or isolated under federal or state quarantine law, up to $1,000,000 shall remain available until expended.  
         Chronic Disease Prevention and Health PromotionFor carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health
         promotion, [$711,650,000] $608,253,000: Provided, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for [not less than] up to 21 States, tribes, or tribal organizations: Provided further, That [of the funds available under this heading, $5,000,000 shall be available to conduct an extension and outreach program to combat
         obesity in counties with the highest levels of obesity: Provided further, That of the funds provided under this heading, $80,000,000 shall be available for a program consisting of three-year grants
         of no less than $100,000 per year to non-governmental entities, local public health offices, school districts, local housing
         authorities, local transportation authorities or Indian tribes to implement evidence-based chronic disease prevention strategies:
         Provided further, That applicants for grants described in the previous proviso shall determine the population to be served and shall agree
         to work in collaboration with multi-sector partners] the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available under
            this heading.  
         Birth Defects, Developmental Disabilities, Disabilities and HealthFor carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities
         and health, [$122,435,000] $61,541,000.  
         Public Health Scientific ServicesFor carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics, and workforce development, [$347,179,000] $377,723,000: Provided, That, in addition to amounts provided herein, [$85,691,000] $95,086,000 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, and XVII of the PHS Act with respect to environmental health, [$147,555,000] $131,811,000.  
         Injury Prevention and ControlFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, [$142,311,000] $188,699,000: Provided, That, in addition to the amounts provided herein, $5,605,000 shall be available from amounts under
            section 241 of the PHS Act to carry out the evaluation of Rape Prevention and Education programs.  
         National Institute for Occupational Safety and HealthFor carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 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, [$180,300,000: Provided, That in addition to amounts provided herein, $112,000,000] $280,590,000 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, 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, and XVII of the PHS Act with respect to global health, [$383,000,000] $464,301,000, of which [$114,250,000] $128,735,000 for international HIV/AIDS shall remain available through September 30, [2015, and of which $7,500,000 shall remain available through September 30, 2015, to support national public health institutes] 2016: 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, 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, [$1,323,450,000, of which $535,000,000 shall remain available until expended for the Strategic National Stockpile: Provided, That in the event the Director of the CDC activates the Emergency Operations Center, the Director of the CDC may detail
         CDC staff without reimbursement for up to 30 days to support the work of the CDC Emergency Operations Center, so long as the
         Director provides a notice to the Committees on Appropriations of the House of Representatives and the Senate within 15 days
         of the use of this authority and a full report within 30 days after use of this authority which includes the number of staff
         and funding level broken down by the originating center and number of days detailed: Provided further, That in the previous proviso the annual reimbursement cannot exceed $3,000,000 across CDC: Provided further, That of the funds provided for the Strategic National Stockpile, up to $2,000,000 shall be used to support a comprehensive
         IOM evaluation of the distribution system] $1,317,375,000: Provided, That, of the amounts available to the Strategic National Stockpile, $542,817,000 shall remain available
            until expended: Provided further, That 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 an activation of the Emergency Operations
            Center at the CDC.  
         Cdc-Wide Activities and Program Support
         (including transfer of funds)For carrying out titles II, III, 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'', "Energy Employees Occupational Illness Compensation Program'', "Global
         Health'', "Public Health Preparedness and Response'', and "Public Health Scientific Services'', [$517,570,000, of which $380,000,000 shall be available until September 30, 2015, for business services and transfer to the
         Working Capital Fund ,] and for carrying out section 4001 of Public Law 111â148, $123,570,000,of which [$24,000,000] $10,000,000 shall be available until September 30, 2018, for [acquisition of real property,] equipment, construction and renovation of facilities: 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 CDC: Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase,
         hire, maintenance, and operation of aircraft for use and support of the activities of CDC: Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities,
         or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal
         employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service,
         or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses
         when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged
         with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program shall be available through
         September 30, [2015] 2016: 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 [to facilitate the implementation of the permanent Working Capital Fund ("WCF'') authorized under this heading in division
         F of Public Law 112â74, on or after enactment of this Act, unobligated balances of amounts appropriated for business services
         for fiscal year 2013 shall be transferred to the WCF: Provided further, That on or after enactment of this Act, CDC shall transfer amounts available for business services to other CDC appropriations
         consistent with the benefit each appropriation received from the business services appropriation in fiscal year 2013: Provided further, That once the WCF is implemented in fiscal year 2014, assets purchased in any prior fiscal year with funds appropriated
         for or reimbursed to business services may be transferred to the WCF and customers billed for depreciation of those assets:
         Provided further, That CDC shall, consistent with the authorities provided in 42 U.S.C. 231, ensure that the WCF is used only for administrative
         support services and not for programmatic activities: Provided further, That CDC shall notify the Committees on Appropriations of the House of Representatives and the Senate not later than 15
         days prior to any transfers made with funds provided under this heading] the Director may transfer funds between any of the accounts of CDC with notification to the Comittees on Appropriations of
            both Houses of Congress at least 15 days in advance of any transfer, but no such account shall be decreased by more than 3
            percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â999
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  0220
                  Cooperative Research and Development Agreements, Centers for Disease Control
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  1
                  2
                  2
               
               
                  
                  Appropriations:
               
               
                  0500
                  CDC-Wide Activities and Program Support
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â999
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Birth Defects, Developmental Disabilities, Disability and Health (0958)
                  130
                  132
                  132
               
               
                  0002
                  CDC Wide Activities and Program Support (0943)
                  1,099
                  299
                  124
               
               
                  0004
                  Chronic Disease Prevention and Health Promotion (0948)
                  739
                  1,188
                  1,078
               
               
                  0005
                  Emerging and Zoonotics Infectious Diseases (0949)
                  246
                  393
                  445
               
               
                  0006
                  Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                  50
                  50
                  55
               
               
                  0007
                  Environmental Health (0947)
                  102
                  180
                  169
               
               
                  0008
                  Global Health (0955)
                  332
                  414
                  465
               
               
                  0012
                  HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                  1,045
                  1,121
                  1,128
               
               
                  0013
                  Immunization and Respiratory Diseases (0951)
                  563
                  772
                  735
               
               
                  0015
                  Injury Prevention and Control (0952)
                  130
                  151
                  189
               
               
                  0016
                  Occupational Safety and Health (0953)
                  172
                  221
                  
               
               
                  0019
                  Public Health Preparedness and Response (0956)
                  1,255
                  1,371
                  1,317
               
               
                  0020
                  Public Health Scientific Services (0959)
                  144
                  397
                  431
               
               
                  0021
                  Cooperative Research and Development Agreements (CRADA) (5146)
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  6,008
                  6,691
                  6,270
               
               
                  0802
                  Reimbursable program activity
                  588
                  541
                  738
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  588
                  541
                  738
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  6,596
                  7,232
                  7,008
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  182
                  165
                  166
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  182
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  46
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  228
                  165
                  166
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  5,657
                  5,807
                  5,400
               
               
                  1120
                  Appropriations transferred to other accts [75â0350]
                  â8
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â9915]
                  59
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â9912]
                  2
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0140]
                  2
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0142]
                  5
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0350]
                  16
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â296
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  5,437
                  5,807
                  5,400
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  55
                  55
                  55
               
               
                  1201
                  Appropriation (special or trust fund)
                  1
                  2
                  2
               
               
                  1221
                  Appropriations transferred from other accts [75â0116]
                  463
                  831
                  809
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  514
                  883
                  866
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  329
                  541
                  736
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  260
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  589
                  541
                  736
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  
                  2
                  2
               
               
                  1900
                  Budget authority (total)
                  6,540
                  7,233
                  7,004
               
               
                  1930
                  Total budgetary resources available
                  6,768
                  7,398
                  7,170
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â7
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  165
                  166
                  162
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,312
                  5,779
                  6,052
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  6,596
                  7,232
                  7,008
               
               
                  3011
                  Obligations incurred, expired accounts
                  32
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â6,979
                  â6,959
                  â6,909
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â46
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â136
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5,779
                  6,052
                  6,151
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â461
                  â429
                  â429
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â260
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  292
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â429
                  â429
                  â429
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,851
                  5,350
                  5,623
               
               
                  3200
                  Obligated balance, end of year
                  5,350
                  5,623
                  5,722
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  6,026
                  6,348
                  6,136
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,373
                  2,539
                  2,470
               
               
                  4011
                  Outlays from discretionary balances
                  3,898
                  3,328
                  3,531
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  6,271
                  5,867
                  6,001
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â603
                  â532
                  â727
               
               
                  4033
                  Non-Federal sources
                  â7
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â610
                  â541
                  â736
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â260
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  281
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  5,437
                  5,807
                  5,400
               
               
                  4080
                  Outlays, net (discretionary)
                  5,661
                  5,326
                  5,265
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  514
                  885
                  868
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  128
                  329
                  321
               
               
                  4101
                  Outlays from mandatory balances
                  580
                  763
                  587
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  708
                  1,092
                  908
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  â2
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  5,951
                  6,690
                  6,266
               
               
                  4190
                  Outlays, net (total)
                  6,369
                  6,416
                  6,171
               
               
                  
                     
                  
               
            
         
      
      
         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, public health preparedness
            and emergency response, and CDC-Wide Activities and Program Support.  The 2013 levels in MAX are not comparable with 2014
            and the 2015 Budget levels.  In 2014, CDC implemented a Working Capital Fund, which realigned business support services from
            the prior fiscal year to the program budget lines based on 2013 consumption data.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â999
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  700
                  706
                  713
               
               
                  11.3
                  Other than full-time permanent
                  98
                  102
                  102
               
               
                  11.5
                  Other personnel compensation
                  25
                  24
                  24
               
               
                  11.7
                  Military personnel
                  70
                  65
                  65
               
               
                  11.8
                  Special personal services payments
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  894
                  898
                  905
               
               
                  12.1
                  Civilian personnel benefits
                  251
                  252
                  254
               
               
                  12.2
                  Military personnel benefits
                  48
                  44
                  44
               
               
                  13.0
                  Benefits for former personnel
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  37
                  33
                  40
               
               
                  22.0
                  Transportation of things
                  12
                  10
                  9
               
               
                  23.1
                  Rental payments to GSA
                  35
                  59
                  60
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  32
                  34
                  35
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  541
                  796
                  681
               
               
                  25.2
                  Other services from non-Federal sources
                  207
                  198
                  135
               
               
                  25.3
                  Other goods and services from Federal sources
                  253
                  293
                  240
               
               
                  25.4
                  Operation and maintenance of facilities
                  67
                  48
                  37
               
               
                  25.5
                  Research and development contracts
                  37
                  41
                  31
               
               
                  25.6
                  Medical care
                  5
                  7
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  39
                  32
                  25
               
               
                  25.8
                  Subsistence and support of persons
                  
                  1
                  30
               
               
                  26.0
                  Supplies and materials
                  561
                  299
                  297
               
               
                  31.0
                  Equipment
                  53
                  54
                  52
               
               
                  32.0
                  Land and structures
                  19
                  11
                  11
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,911
                  3,575
                  3,372
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  6,008
                  6,691
                  6,270
               
               
                  99.0
                  Reimbursable obligations
                  588
                  541
                  738
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  6,596
                  7,232
                  7,008
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0943â0â1â999
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8,764
                  8,764
                  8,764
               
               
                  1101
                  Direct military average strength employment
                  800
                  800
                  800
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,159
                  1,159
                  1,159
               
               
                  2101
                  Reimbursable military average strength employment
                  101
                  101
                  101
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital Fund                                                                                                 
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4553â0â4â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  520
                  517
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.3)
                  
                  520
                  517
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  520
                  517
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  
                  520
                  517
               
               
                  1900
                  Budget authority (total)
                  
                  520
                  517
               
               
                  1930
                  Total budgetary resources available
                  
                  520
                  517
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  520
                  517
               
               
                  3020
                  Outlays (gross)
                  
                  â520
                  â517
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  520
                  517
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  520
                  517
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  
                  â520
                  â517
               
               
                  
                     
                  
               
            
         
      
      
         Implemented in 2014, CDC's new Working Capital Fund has extended availability and serves as the funding mechanism to finance
            centralized business services support across CDC. Services rendered under the fund are performed at pre-established rates
            that are used to cover the full cost of operations and future investments. Contributions are collected for services, thereby
            creating market-like incentives to maximize efficiency and quality.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4553â0â4â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  520
                  517
               
               
                  99.0
                  Reimbursable obligations
                  
                  520
                  517
               
               
                  
                     
                  
               
            
         
      
         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)[; section 118(f) of the Superfund Amendments and Reauthorization Act of 1986 (SARA);] and section 3019 of the Solid Waste Disposal Act, $74,691,000, 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)] 104(i) of CERCLA during fiscal year [2014] 2015, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program
                  75
                  75
                  75
               
               
                  0801
                  Reimbursable program
                  4
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  79
                  85
                  85
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  17
                  14
                  14
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  76
                  75
                  75
               
               
                  1130
                  Appropriations permanently reduced
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  72
                  75
                  75
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  20
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2
                  10
                  10
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4
                  10
                  10
               
               
                  1900
                  Budget authority (total)
                  76
                  85
                  105
               
               
                  1930
                  Total budgetary resources available
                  93
                  99
                  119
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  14
                  14
                  34
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  52
                  42
                  33
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  79
                  85
                  85
               
               
                  3020
                  Outlays (gross)
                  â87
                  â94
                  â98
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  42
                  33
                  20
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â14
                  â10
                  â10
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â10
                  â10
                  â10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  38
                  32
                  23
               
               
                  3200
                  Obligated balance, end of year
                  32
                  23
                  10
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  76
                  85
                  85
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  51
                  63
                  63
               
               
                  4011
                  Outlays from discretionary balances
                  32
                  31
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  83
                  94
                  84
               
               
                  
                  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2
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  72
                  75
                  75
               
               
                  4080
                  Outlays, net (discretionary)
                  74
                  84
                  74
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  20
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  14
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4
                  
                  14
               
               
                  4180
                  Budget authority, net (total)
                  72
                  75
                  95
               
               
                  4190
                  Outlays, net (total)
                  78
                  84
                  88
               
               
                  
                     
                  
               
            
         
      
      
         The Agency for Toxic Substances and Disease Registry (ATSDR) is authorized under the Comprehensive Environmental Response,
            Compensation, and Liability Act of 1980 (CERCLA). ATSDR's mission is to use the best science, take responsive action, and
            provide trustworthy health information to prevent and mitigate harmful exposures to toxic substances and related disease.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  22
                  23
                  24
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  4
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  28
                  29
                  30
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  8
                  8
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  2
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  5
                  5
                  3
               
               
                  25.1
                  Advisory and assistance services
                  3
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  5
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  7
                  7
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16
                  14
                  14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  75
                  75
                  75
               
               
                  99.0
                  Reimbursable obligations
                  4
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  79
                  85
                  85
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0944â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  240
                  240
                  240
               
               
                  1101
                  Direct military average strength employment
                  38
                  38
                  38
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  9
                  9
                  9
               
               
                  2101
                  Reimbursable military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program Fund                                                                                   
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal Share
                  230
                  268
                  282
               
               
                  0002
                  NYC
                  26
                  30
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  256
                  298
                  313
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  107
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (WTC (CDC Direct))
                  234
                  382
                  282
               
               
                  1200
                  Appropriation (WTCâNYC DHSSâCDC)
                  26
                  42
                  31
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â10
                  â19
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  250
                  405
                  313
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  6
                  
                  
               
               
                  1900
                  Budget authority (total)
                  256
                  405
                  313
               
               
                  1930
                  Total budgetary resources available
                  256
                  405
                  420
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  107
                  107
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  114
                  162
                  177
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  256
                  298
                  313
               
               
                  3020
                  Outlays (gross)
                  â191
                  â283
                  â365
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  162
                  177
                  125
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  114
                  162
                  177
               
               
                  3200
                  Obligated balance, end of year
                  162
                  177
                  125
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  256
                  405
                  313
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  125
                  203
                  157
               
               
                  4101
                  Outlays from mandatory balances
                  66
                  80
                  208
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  191
                  283
                  365
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â21
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  250
                  405
                  313
               
               
                  4170
                  Outlays, net (mandatory)
                  170
                  283
                  365
               
               
                  4180
                  Budget authority, net (total)
                  250
                  405
                  313
               
               
                  4190
                  Outlays, net (total)
                  170
                  283
                  365
               
               
                  
                     
                  
               
            
         
      
      
         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 2014 and 2015 Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â551
                  2013 actual
                  2014 est.
                  2015 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
                  18
                  18
                  20
               
               
                  25.2
                  Other services from non-Federal sources
                  71
                  82
                  33
               
               
                  25.3
                  Other goods and services from Federal sources
                  10
                  5
                  4
               
               
                  25.6
                  Medical care
                  134
                  170
                  233
               
               
                  41.0
                  Grants, subsidies, and contributions
                  20
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  256
                  298
                  313
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0946â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  18
                  18
                  18
               
               
                  1101
                  Direct military average strength employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         Federal Funds
         National Cancer InstituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer, [$4,923,238,000] $4,930,715,000, of which up to $8,000,000 may be used for facilities repairs and improvements at the National Cancer InstituteâFrederick
         Federally Funded Research and Development Center in Frederick, Maryland. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$2,988,605,000] $2,987,685,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$398,650,000] $397,131,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$1,744,274,000] $1,743,336,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$1,587,982,000] $1,608,461,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$4,358,841,000] $4,423,357,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Institute of General Medical SciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,364,147,000: Provided, That not less than $273,325,000 is provided for the Institutional Development Awards program] $2,368,877,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$1,282,595,000] $1,283,487,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Eye InstituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$682,077,000] $675,168,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Institute of Environmental Health SciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, [$665,439,000] $665,080,000. (Department of Health and Human Services Appropriations Act, 2014.)
      For necessary expenses [for] of 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 (42 U.S.C. 9660(a)) and section 126(g) of the Superfund Amendments
         and Reauthorization Act of 1986, $77,349,000. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2014.)
         National Institute on AgingFor carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,171,038,000] $1,170,880,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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,
         [$520,053,000] $520,189,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$404,049,000] $403,933,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Institute of Nursing ResearchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$140,517,000] $140,452,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$446,025,000] $446,017,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Institute on Drug AbuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,025,435,000] $1,023,268,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Institute of Mental HealthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,446,172,000] $1,440,076,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Human Genome Research InstituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$497,813,000] $498,451,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$329,172,000] $328,532,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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, [$124,296,000] $124,509,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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,
         [$268,322,000] $267,953,000. (Department of Health and Human Services Appropriations Act, 2014.)
         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), [$67,577,000] $67,776,000. (Department of Health and Human Services Appropriations Act, 2014.)
         National Library of MedicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$327,723,000, of which] $372,851,000: Provided, That, of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, [2015 , for improvement of information systems] 2016: Provided further, That, in fiscal year [2014] 2015, 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. (Department of Health and Human Services Appropriations Act, 2014.)
         National Center for Advancing Translational SciencesFor carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$633,267,000] $657,471,000: Provided, That up to [$9,835,000] $29,810,000 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network[: Provided further, That at least $474,746,000 is provided to the Clinical and Translational Sciences Awards program]. (Department of Health and Human Services Appropriations Act, 2014.)
         Office of the DirectorFor carrying out the responsibilities of the Office of the Director, NIH, [$1,400,134,000] $1,451,786,000, of which up to [$25,000,000] $30,000,000 shall be used to carry out section [213] 212 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 $165,000,000 shall be for the National Children's Study ("NCS''), except that not later than July 15, [2014] 2015, the Director shall estimate the amount needed for the NCS during fiscal year [2014] 2015, and any funds in excess of the estimated need shall be transferred to and merged with the accounts for the various Institutes
         and Centers in proportion to their shares of total NIH appropriations made by this Act: Provided further, That [$533,039,000] $583,039,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided $10,000 shall be for official reception and representation expenses when specifically approved
         by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants
         for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act: Provided further, That the Director may direct up to 1 percent of the total made available in this or any other Act to all
            National Institutes of Health appropriations to activities that the Director may so designate: Provided further, That no such
            appropriation shall be decreased by more than 1 percent by any such transfers and that the Congress is promptly notified of
            the transfer. (Department of Health and Human Services Appropriations Act, 2014.)
         Buildings and FacilitiesFor the study of, construction or demolition of, renovation of, and acquisition of equipment for, facilities of or used by
         NIH, including the acquisition of real property, [$128,663,000] $128,663,000, to remain available until [September 30, 2018, of which up to $7,000,000 may be used for demolition] expended. (Department of Health and Human Services Appropriations Act, 2014.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  0220
                  Cooperative Research and Development Agreements, NIH
                  18
                  17
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  18
                  17
                  17
               
               
                  
                  Appropriations:
               
               
                  0500
                  National Institutes of Health
                  â18
                  â17
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  National Cancer Institute (0849)
                  4,789
                  4,929
                  4,931
               
               
                  0002
                  National Heart, Lung, and Blood Institute (0872)
                  2,904
                  2,987
                  2,988
               
               
                  0003
                  National Institute of Dental and Craniofacial Research (0873)
                  387
                  398
                  397
               
               
                  0004
                  National Institute of Diabetes and Digestive and Kidney Disease (0884)
                  1,695
                  1,744
                  1,743
               
               
                  0005
                  National Institute of Neurological Disorders and Stroke (0886)
                  1,534
                  1,588
                  1,608
               
               
                  0006
                  National Institute of Allergy and Infectious Diseases (0885)
                  4,235
                  4,399
                  4,423
               
               
                  0007
                  National Institute of General Medical Sciences (0851)
                  2,293
                  2,365
                  2,369
               
               
                  0008
                  National Institute of Child Health and Human Development (0844)
                  1,246
                  1,283
                  1,283
               
               
                  0009
                  National Eye Institute (0887)
                  657
                  675
                  675
               
               
                  0010
                  National Institute of Environmental Health Sciences (0862)
                  721
                  742
                  742
               
               
                  0011
                  National Institute on Aging (0843)
                  1,041
                  1,171
                  1,171
               
               
                  0012
                  National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                  505
                  520
                  520
               
               
                  0013
                  National Institute on Deafness and Other Communication Disorder (0890)
                  393
                  404
                  404
               
               
                  0014
                  National Institute of Mental Health (0892)
                  1,396
                  1,419
                  1,440
               
               
                  0015
                  National Institute on Drug Abuse (0893)
                  993
                  1,017
                  1,023
               
               
                  0016
                  National Institute on Alcohol Abuse and Alcoholism (0894)
                  433
                  446
                  446
               
               
                  0017
                  National Institute of Nursing Research (0889)
                  137
                  141
                  141
               
               
                  0018
                  National Human Genome Research Institute (0891)
                  484
                  498
                  498
               
               
                  0019
                  National Institute of Biomedical Imaging and Bioengineering (0898)
                  319
                  327
                  329
               
               
                  0021
                  National Center for Complementary and Alternative Medicine (0896)
                  121
                  124
                  125
               
               
                  0022
                  National Institute on Minority Health and Health Disparities (0897)
                  261
                  268
                  268
               
               
                  0023
                  John E. Fogarty International Center (0819)
                  66
                  68
                  68
               
               
                  0024
                  National Library of Medicine (0807)
                  317
                  328
                  373
               
               
                  0025
                  Office of the Director (0846)
                  1,412
                  1,400
                  1,452
               
               
                  0026
                  Buildings and facilities (0838)
                  167
                  129
                  129
               
               
                  0027
                  Cooperative Research and Development Agreements
                  21
                  17
                  17
               
               
                  0028
                  National Center for Advancing Translational Sciences (0875)
                  543
                  633
                  657
               
               
                  0031
                  Type 1 Diabetes
                  142
                  139
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  29,212
                  30,159
                  30,220
               
               
                  0801
                  Reimbursable - Other
                  3,151
                  3,192
                  3,201
               
               
                  0802
                  Royalties
                  92
                  179
                  179
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  3,243
                  3,371
                  3,380
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  3,243
                  3,371
                  3,380
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  32,455
                  33,530
                  33,600
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  458
                  739
                  564
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  253
                  702
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  59
                  4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  517
                  743
                  564
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  30,780
                  30,003
                  30,203
               
               
                  1120
                  Appropriations transferred to other accts [75â0943]
                  â59
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0511]
                  â114
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0140]
                  149
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â1,607
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  29,149
                  30,003
                  30,203
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  150
                  
               
               
                  1201
                  Appropriation (special or trust fund)
                  18
                  17
                  17
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â8
                  â11
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  160
                  156
                  17
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2,609
                  3,192
                  3,201
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  762
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  3,371
                  3,192
                  3,201
               
               
                  1900
                  Budget authority (total)
                  32,680
                  33,351
                  33,421
               
               
                  1930
                  Total budgetary resources available
                  33,197
                  34,094
                  33,985
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  739
                  564
                  385
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  33,050
                  31,107
                  30,317
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  32,455
                  33,530
                  33,600
               
               
                  3011
                  Obligations incurred, expired accounts
                  203
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â34,173
                  â34,316
                  â32,870
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â59
                  â4
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â369
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  31,107
                  30,317
                  31,047
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â938
                  â1,253
                  â1,253
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â762
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  447
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,253
                  â1,253
                  â1,253
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  32,112
                  29,854
                  29,064
               
               
                  3200
                  Obligated balance, end of year
                  29,854
                  29,064
                  29,794
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  32,520
                  33,195
                  33,404
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  10,579
                  11,293
                  11,356
               
               
                  4011
                  Outlays from discretionary balances
                  23,438
                  22,905
                  21,384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  34,017
                  34,198
                  32,740
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,080
                  â3,192
                  â3,201
               
               
                  4033
                  Non-Federal sources
                  â117
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â3,197
                  â3,192
                  â3,201
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â762
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  588
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â174
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  29,149
                  30,003
                  30,203
               
               
                  4080
                  Outlays, net (discretionary)
                  30,820
                  31,006
                  29,539
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  160
                  156
                  17
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7
                  49
                  17
               
               
                  4101
                  Outlays from mandatory balances
                  149
                  69
                  113
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  156
                  118
                  130
               
               
                  4180
                  Budget authority, net (total)
                  29,309
                  30,159
                  30,220
               
               
                  4190
                  Outlays, net (total)
                  30,976
                  31,124
                  29,669
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  29,309
                  30,159
                  30,220
               
               
                  
                  Outlays
                  30,976
                  31,124
                  29,669
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  150
               
               
                  
                  Outlays
                  
                  
                  36
               
               
                  Total:
               
               
                  
                  Budget Authority
                  29,309
                  30,159
                  30,370
               
               
                  
                  Outlays
                  30,976
                  31,124
                  29,705
               
               
                  
                     
                  
               
            
         
      
      
         DISTRIBUTION OF BUDGET AUTHORITY AND OUTLAYS BY ACCOUNT (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2013
                     2014
                     2015
                  
                  
                     
                        
                     
                  
                  
                     Distribution of budget authority by account:
                     
                     
                     
                  
                  
                     National Cancer Institute
                     4,789
                     4,929
                     4,931
                  
                  
                     National Heart, Lung, and Blood Institute
                     2,904
                     2,987
                     2,988
                  
                  
                     National Institute of Dental and Craniofacial Research
                     387
                     398
                     397
                  
                  
                     National Institute of Diabetes and Digestive and Kidney Diseases
                     1,695
                     1,744
                     1,743
                  
                  
                     National Institute of Neurological Disorder and Stroke
                     1,534
                     1,588
                     1,608
                  
                  
                     National Institute of Allergy and Infectious Diseases
                     4,235
                     4,399
                     4,423
                  
                  
                     National Institute of General Medical Sciences
                     2,293
                     2,365
                     2,369
                  
                  
                     Eunice Kennedy Shriver National Institute of Child Health and Human Development
                     1,246
                     1,283
                     1,283
                  
                  
                     National Eye Institute
                     657
                     675
                     675
                  
                  
                     National Institute of Environmental Health Sciences
                     721
                     742
                     742
                  
                  
                     National Institute on Aging
                     1,041
                     1,171
                     1,171
                  
                  
                     National Institute of Arthritis and Musculoskeletal and Skin Diseases
                     505
                     520
                     520
                  
                  
                     National Institute on Deafness and Other Communication Disorders
                     393
                     404
                     404
                  
                  
                     National Institute of Mental Health
                     1,396
                     1,419
                     1,440
                  
                  
                     National Institute on Drug Abuse
                     993
                     1,017
                     1,023
                  
                  
                     National Institute on Alcohol Abuse and Alcoholism
                     433
                     446
                     446
                  
                  
                     National Institute of Nursing Research
                     137
                     141
                     141
                  
                  
                     National Center for Research Resources
                     0
                     0
                     0
                  
                  
                     National Human Genome Research Institute
                     484
                     498
                     498
                  
                  
                     National Institute of Biomedical Imaging and Bioengineering
                     319
                     327
                     329
                  
                  
                     National Institute on Minority Health and Health Disparities
                     261
                     268
                     268
                  
                  
                     National Center for Complementary and Alternative Medicine
                     121
                     124
                     125
                  
                  
                     National Center for Advancing Translational Sciences
                     543
                     633
                     657
                  
                  
                     John E. Fogarty International Center
                     66
                     68
                     68
                  
                  
                     National Library of Medicine
                     317
                     328
                     373
                  
                  
                     Office of the Director
                     1,412
                     1,400
                     1,452
                  
                  
                     Buildings and Facilities
                     167
                     129
                     129
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Subtotal
                     29,049
                     30,003
                     30,203
                  
                  
                     Cooperative Research and Development Agreements
                     21
                     17
                     17
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Budget Authority, NIH
                     29,070
                     30,020
                     30,220
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2013
                     2014
                     2015
                  
                  
                     
                        
                     
                  
                  
                     Distribution of outlays by account:
                     
                     
                     
                  
                  
                     National Cancer Institute
                     4,867
                     5,075
                     4,832
                  
                  
                     National Heart, Lung, and Blood Institute
                     3,021
                     2,945
                     2,926
                  
                  
                     National Institute of Dental and Craniofacial Research
                     401
                     430
                     390
                  
                  
                     National Institute of Diabetes and Digestive and Kidney Diseases
                     1,908
                     2,067
                     1,710
                  
                  
                     National Institute of Neurological Disorders and Stroke
                     1,593
                     1,735
                     1,560
                  
                  
                     National Institute of Allergy and Infectious Diseases
                     4,514
                     4,250
                     4,314
                  
                  
                     National Institute of General Medical Sciences
                     2,574
                     2,583
                     2,315
                  
                  
                     Eunice Kennedy Shriver National Institute of Child Health and Human Development
                     1,298
                     1,388
                     1,257
                  
                  
                     National Eye Institute
                     707
                     693
                     661
                  
                  
                     National Institute of Environmental Health Sciences
                     507
                     718
                     728
                  
                  
                     National Institute on Aging
                     1,074
                     1,115
                     1,127
                  
                  
                     National Institute of Arthritis and Musculoskeletal and Skin Diseases
                     517
                     540
                     509
                  
                  
                     National Institute on Deafness and Other Communication Disorders
                     407
                     421
                     396
                  
                  
                     National Institute of Mental Health
                     1,476
                     1,419
                     1,399
                  
                  
                     National Institute on Drug Abuse
                     1,071
                     936
                     999
                  
                  
                     National Institute on Alcohol Abuse and Alcoholism
                     469
                     448
                     437
                  
                  
                     National Institute of Nursing Research
                     143
                     138
                     138
                  
                  
                     National Center for Research Resources
                     125
                     83
                     28
                  
                  
                     National Human Genome Research Institute
                     470
                     567
                     488
                  
                  
                     National Institute of Biomedical Imaging and Bioengineering
                     330
                     338
                     320
                  
                  
                     National Institute on Minority Health and Health Disparities
                     248
                     262
                     260
                  
                  
                     National Center for Complementary and Alternative Medicine
                     125
                     128
                     122
                  
                  
                     National Center for Advancing Translational Sciences
                     476
                     564
                     578
                  
                  
                     John E. Fogarty International Center
                     67
                     73
                     66
                  
                  
                     National Library of Medicine
                     318
                     336
                     345
                  
                  
                     Office of the Director
                     1,324
                     1,504
                     1,387
                  
                  
                     Buildings and Facilities
                     95
                     83
                     91
                  
                  
                     ARRA Funds
                     935
                     273
                     273
                  
                  
                     Management Fund/Service and Supply Fund
                     â103
                     
                     
                  
                  
                     Subtotal Outlays
                     
                     
                     
                  
                  
                     Cooperative Research and Development Agreements
                     18
                     16
                     16
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Outlays, NIH
                     30,975
                     31,125
                     29,670
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  905
                  921
                  931
               
               
                  11.3
                  Other than full-time permanent
                  463
                  468
                  473
               
               
                  11.5
                  Other personnel compensation
                  18
                  19
                  19
               
               
                  11.7
                  Military personnel
                  21
                  21
                  22
               
               
                  11.8
                  Special personal services payments
                  160
                  160
                  162
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,567
                  1,589
                  1,607
               
               
                  12.1
                  Civilian personnel benefits
                  422
                  430
                  445
               
               
                  12.2
                  Military personnel benefits
                  15
                  15
                  15
               
               
                  21.0
                  Travel and transportation of persons
                  43
                  45
                  45
               
               
                  22.0
                  Transportation of things
                  5
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  2
                  2
                  2
               
               
                  23.2
                  Rental payments to others
                  
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  28
                  29
                  29
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  112
                  114
                  115
               
               
                  25.2
                  Other services from non-Federal sources
                  732
                  791
                  760
               
               
                  25.3
                  Other goods and services from Federal sources
                  2,872
                  2,985
                  3,032
               
               
                  25.4
                  Operation and maintenance of facilities
                  210
                  174
                  174
               
               
                  25.5
                  Research and development contracts
                  2,072
                  2,201
                  2,180
               
               
                  25.6
                  Medical care
                  21
                  22
                  22
               
               
                  25.7
                  Operation and maintenance of equipment
                  106
                  108
                  109
               
               
                  26.0
                  Supplies and materials
                  178
                  185
                  184
               
               
                  31.0
                  Equipment
                  131
                  136
                  135
               
               
                  41.0
                  Grants, subsidies, and contributions
                  20,695
                  21,326
                  21,359
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  29,212
                  30,159
                  30,220
               
               
                  99.0
                  Reimbursable obligations
                  3,243
                  3,371
                  3,380
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  32,455
                  33,530
                  33,600
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  13,255
                  13,240
                  13,240
               
               
                  1101
                  Direct military average strength employment
                  200
                  200
                  200
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  4,675
                  4,690
                  4,690
               
               
                  2101
                  Reimbursable military average strength employment
                  100
                  100
                  100
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9915â4â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  150
               
               
                  1900
                  Budget authority (total)
                  
                  
                  150
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  150
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  114
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  114
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  36
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  36
               
               
                  
                     
                  
               
            
         
      
         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, [$1,055,347,000] $992,792,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available
         for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, [$21,039,000] $26,039,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for mental health activities and 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 [2014] 2015: Provided further, That [of the amount appropriated under this heading, $46,000,000 shall be for the National Child Traumatic Stress Initiative as
         described in section 582 of the PHS Act] notwithstanding section 565(b)(1) of the PHS Act, technical assistance may be provided to a public entity to establish or
            operate a system of comprehensive community mental health services to children with a serious emotional disturbance, without
            regard to whether the public entity receives a grant under section 561(a) of such Act: Provided further, That States shall expend at least 5 percent of the amount each receives for carrying out section 1911 of the PHS Act to
         support evidence-based [programs that] mental health prevention and treatment practices to address the needs of individuals with early serious mental illness, including psychotic disorders, regardless of the age
         of the individual at onset: Provided further, That none of the funds provided for section 1911 of the PHS Act shall be subject to section 241 of such Act.  
         Substance Abuse TreatmentFor carrying out titles III[,] and V[, and XIX] of the PHS Act with respect to substance abuse treatment and [section 1922(a) of the PHS Act] title XIX of such Act with respect to substance abuse treatment and prevention, [$2,052,661,000] $2,008,056,000: Provided, That in addition to amounts provided herein, [the following amounts] $109,200,000 shall be available under section 241 of the PHS Act[: (1) $79,200,000] to supplement funds otherwise available for substance abuse treatment activities and to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance, national data,
         data collection and evaluation activities, and further that the total available under this Act for section 1935(b) activities
         shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX[; and (2) $2,000,000 to evaluate substance abuse treatment programs]: Provided further, That none of the funds provided for section 1921 of the PHS Act shall be subject to section 241 of such Act.  
         Substance Abuse PreventionFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$175,631,000] $169,092,000: Provided, That in addition to amounts provided herein, $16,468,000 shall be available under section 241 of
            the PHS Act to supplement funds otherwise available for substance abuse prevention activities.  
         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, [$151,296,000] $127,729,000: Provided, That in addition to amounts provided herein, [$30,428,000] $58,995,000 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 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 amounts made available in this Act for carrying out section 501(m) of the PHS Act shall remain available
            through September 30, 2016: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings
         "Mental Health'', "Substance Abuse Treatment'', and "Substance Abuse Prevention'': Provided further, That the Administrator may transfer funds between any of the accounts of SAMHSA with notification to the
            Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account shall
            be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0006
                  Mental Health
                  894
                  1,055
                  999
               
               
                  0007
                  Substance Abuse Treatment
                  2,033
                  2,052
                  2,002
               
               
                  0008
                  Substance Abuse Prevention
                  176
                  176
                  169
               
               
                  0009
                  Health Surveillance and Program Support
                  121
                  152
                  128
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total, direct program
                  3,224
                  3,435
                  3,298
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,224
                  3,435
                  3,298
               
               
                  0802
                  Reimbursables
                  280
                  249
                  328
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  3,504
                  3,684
                  3,626
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  63
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,349
                  3,435
                  3,298
               
               
                  1120
                  Appropriations transferred to other accts [75â0350]
                  â1
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0350]
                  15
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1536]
                  21
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1515]
                  2
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â175
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,211
                  3,435
                  3,298
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [75â0116]
                  15
                  62
                  58
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  15
                  62
                  58
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  145
                  249
                  330
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  135
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  280
                  249
                  330
               
               
                  1900
                  Budget authority (total)
                  3,506
                  3,746
                  3,686
               
               
                  1930
                  Total budgetary resources available
                  3,506
                  3,747
                  3,749
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  63
                  123
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3,125
                  3,219
                  2,953
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  3,504
                  3,684
                  3,626
               
               
                  3011
                  Obligations incurred, expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3,378
                  â3,950
                  â3,739
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â42
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,219
                  2,953
                  2,840
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â22
                  â143
                  â143
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â135
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â143
                  â143
                  â143
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3,103
                  3,076
                  2,810
               
               
                  3200
                  Obligated balance, end of year
                  3,076
                  2,810
                  2,697
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,491
                  3,684
                  3,628
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,176
                  1,554
                  1,583
               
               
                  4011
                  Outlays from discretionary balances
                  2,167
                  2,289
                  2,100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,343
                  3,843
                  3,683
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â153
                  â249
                  â328
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â153
                  â249
                  â330
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â135
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â127
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,211
                  3,435
                  3,298
               
               
                  4080
                  Outlays, net (discretionary)
                  3,190
                  3,594
                  3,353
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  15
                  62
                  58
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  4
                  24
                  22
               
               
                  4101
                  Outlays from mandatory balances
                  31
                  83
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  35
                  107
                  56
               
               
                  4180
                  Budget authority, net (total)
                  3,226
                  3,497
                  3,356
               
               
                  4190
                  Outlays, net (total)
                  3,225
                  3,701
                  3,409
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  48
                  51
                  51
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  
                  1
                  1
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  55
                  59
                  59
               
               
                  12.1
                  Civilian personnel benefits
                  15
                  16
                  16
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  6
                  6
                  10
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  54
                  48
                  50
               
               
                  25.2
                  Other services from non-Federal sources
                  163
                  204
                  192
               
               
                  25.3
                  Other goods and services from Federal sources
                  33
                  63
                  70
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  1
                  1
               
               
                  25.5
                  Research and development contracts
                  
                  4
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,892
                  3,029
                  2,891
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,224
                  3,435
                  3,298
               
               
                  99.0
                  Reimbursable obligations
                  280
                  249
                  328
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  3,504
                  3,684
                  3,626
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1362â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  492
                  520
                  509
               
               
                  1101
                  Direct military average strength employment
                  34
                  35
                  37
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  66
                  85
                  93
               
               
                  2101
                  Reimbursable military average strength employment
                  16
                  15
                  16
               
               
                  
                     
                  
               
            
         
      
         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, [$364,008,000] $334,099,000 shall be available from amounts available under section 241 of the PHS Act, notwithstanding subsection 947(c) of such Act:
         Provided, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the
         sale of data shall be credited to this appropriation and shall remain available until [September 30, 2015] expended. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0003
                  Prevention and Public Health Fund
                  6
                  7
                  
               
               
                  0801
                  Reimbursable program
                  15
                  15
                  15
               
               
                  0802
                  Reimbursable program: PHS evaluation
                  366
                  364
                  334
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  381
                  379
                  349
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  387
                  386
                  349
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4
                  21
                  21
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  4
                  21
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other accts [75â0116]
                  6
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  6
                  7
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  121
                  379
                  349
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  256
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  377
                  379
                  349
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  21
                  
                  
               
               
                  1900
                  Budget authority (total)
                  404
                  386
                  349
               
               
                  1930
                  Total budgetary resources available
                  408
                  407
                  370
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  21
                  21
                  21
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  725
                  487
                  151
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  387
                  386
                  349
               
               
                  3011
                  Obligations incurred, expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â613
                  â722
                  â462
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  487
                  151
                  38
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â293
                  â387
                  â387
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â256
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  162
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â387
                  â387
                  â387
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  432
                  100
                  â236
               
               
                  3200
                  Obligated balance, end of year
                  100
                  â236
                  â349
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  377
                  379
                  349
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  126
                  379
                  349
               
               
                  4011
                  Outlays from discretionary balances
                  477
                  331
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  603
                  710
                  449
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â273
                  â379
                  â349
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â256
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  152
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â104
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  330
                  331
                  100
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  27
                  7
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  10
                  12
                  13
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â21
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  6
                  7
                  
               
               
                  4190
                  Outlays, net (total)
                  319
                  343
                  113
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.5
                  Research and development contracts
                  2
                  7
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  6
                  7
                  
               
               
                  99.0
                  Reimbursable obligations
                  381
                  379
                  349
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  387
                  386
                  349
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1700â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  296
                  297
                  297
               
               
                  2101
                  Reimbursable military average strength employment
                  9
                  9
                  9
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  6
                  20
                  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, [$177,872,985,000] $234,608,916,000, to remain available until expended.
      
      For making, after May 31, [2014] 2015, 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 [2014] 2015 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 [2015] 2016, [$103,472,323,000] $113,272,140,000, to remain available until expended.
      
      Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such
         quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  265,069
                  290,533
                  315,239
               
               
                  0002
                  State and local administration
                  17,767
                  18,556
                  18,766
               
               
                  0003
                  Vaccines for Children
                  3,607
                  3,562
                  4,077
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  286,443
                  312,651
                  338,082
               
               
                  0801
                  Medicare Part B premiums
                  477
                  390
                  
               
               
                  0802
                  Medicare Part D
                  
                  
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  477
                  390
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  286,920
                  313,041
                  338,088
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  21,091
                  2,283
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  18,143
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  39,234
                  2,283
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  158,827
                  204,033
                  234,609
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  158,827
                  204,033
                  234,609
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  90,614
                  106,336
                  103,472
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1280
                  Advanced appropriation, mandatory (total)
                  90,614
                  106,336
                  103,472
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  528
                  390
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  528
                  390
                  6
               
               
                  1900
                  Budget authority (total)
                  249,969
                  310,759
                  338,087
               
               
                  1930
                  Total budgetary resources available
                  289,203
                  313,042
                  338,088
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2,283
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  27,899
                  30,756
                  34,967
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  286,920
                  313,041
                  338,088
               
               
                  3020
                  Outlays (gross)
                  â265,920
                  â308,830
                  â331,446
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â18,143
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  30,756
                  34,967
                  41,609
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  27,899
                  30,756
                  34,967
               
               
                  3200
                  Obligated balance, end of year
                  30,756
                  34,967
                  41,609
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  249,969
                  310,759
                  338,087
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  230,914
                  279,612
                  331,446
               
               
                  4101
                  Outlays from mandatory balances
                  35,006
                  29,218
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  265,920
                  308,830
                  331,446
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â477
                  â390
                  â6
               
               
                  4123
                  Non-Federal sources
                  â51
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â528
                  â390
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  249,441
                  310,369
                  338,081
               
               
                  4170
                  Outlays, net (mandatory)
                  265,392
                  308,440
                  331,440
               
               
                  4180
                  Budget authority, net (total)
                  249,441
                  310,369
                  338,081
               
               
                  4190
                  Outlays, net (total)
                  265,392
                  308,440
                  331,440
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  249,441
                  310,369
                  338,081
               
               
                  
                  Outlays
                  265,392
                  308,440
                  331,440
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  
                  7
               
               
                  
                  Outlays
                  
                  
                  7
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  â365
                  â636
               
               
                  
                  Outlays
                  
                  â365
                  â636
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  540
                  5,151
               
               
                  
                  Outlays
                  
                  540
                  5,151
               
               
                  Total:
               
               
                  
                  Budget Authority
                  249,441
                  310,544
                  342,603
               
               
                  
                  Outlays
                  265,392
                  308,615
                  335,962
               
               
                  
                     
                  
               
            
         
      
      
         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
                     2013
                     2014
                     2015
                  
                  
                     
                        
                     
                  
                  
                     Vaccine Purchase
                     3,335
                     3,273
                     3,776
                  
                  
                     Vaccine Stockpile
                     137
                     135
                     138
                  
                  
                     Ordering, Distribution, and Operations
                     94
                     111
                     119
                  
                  
                     Vaccine Management Contract Support
                     1
                     0
                     0
                  
                  
                     Evaluation Activities
                     42
                     43
                     44
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Obligations
                     3,609
                     3,562
                     4,077
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  286,443
                  312,651
                  338,082
               
               
                  99.0
                  Reimbursable obligations
                  477
                  390
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  286,920
                  313,041
                  338,088
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â7â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  7
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  7
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  7
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  7
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â7
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  7
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  7
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  7
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  7
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  
                  124
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  124
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  124
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  124
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  124
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  124
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â124
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  124
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  124
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  â365
                  â760
               
               
                  4180
                  Budget authority, net (total)
                  
                  â365
                  â636
               
               
                  4190
                  Outlays, net (total)
                  
                  â365
                  â636
               
               
                  
                     
                  
               
            
         
      
      
         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 certain 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, and other impacts of the Administration's
            Medicaid proposals.
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  175
                  4,391
               
               
                  0801
                  Medicare Part B Premiums
                  
                  365
                  760
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  540
                  5,151
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  
                  175
                  4,391
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  175
                  4,391
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  365
                  760
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  
                  365
                  760
               
               
                  1900
                  Budget authority (total)
                  
                  540
                  5,151
               
               
                  1930
                  Total budgetary resources available
                  
                  540
                  5,151
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  540
                  5,151
               
               
                  3020
                  Outlays (gross)
                  
                  â540
                  â5,151
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  540
                  5,151
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  540
                  5,151
               
               
                  4180
                  Budget authority, net (total)
                  
                  540
                  5,151
               
               
                  4190
                  Outlays, net (total)
                  
                  540
                  5,151
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0512â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  
                  175
                  4,391
               
               
                  99.0
                  Reimbursable obligations
                  
                  365
                  760
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  540
                  5,151
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations                                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0011
                  Emergency health services for undocumented aliens
                  16
                  7
                  2
               
               
                  0012
                  Medicaid integrity program
                  102
                  132
                  78
               
               
                  0018
                  Money follows the person (MFP) demonstration
                  344
                  434
                  434
               
               
                  0019
                  MFP evaluations and technical support
                  1
                  1
                  1
               
               
                  0023
                  Grants to improve outreach and enrollment
                  34
                  6
                  1
               
               
                  0025
                  Medicaid emergency psychiatric demonstration
                  14
                  30
                  19
               
               
                  0026
                  Incentives for prevention of chronic diseases in Medicaid
                  23
                  22
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  534
                  632
                  543
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,459
                  1,489
                  1,346
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  61
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,521
                  1,489
                  1,346
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  530
                  527
                  528
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â27
                  â38
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  503
                  489
                  528
               
               
                  1900
                  Budget authority (total)
                  503
                  489
                  528
               
               
                  1930
                  Total budgetary resources available
                  2,024
                  1,978
                  1,874
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,489
                  1,346
                  1,331
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  765
                  715
                  598
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  534
                  632
                  543
               
               
                  3011
                  Obligations incurred, expired accounts
                  9
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â517
                  â749
                  â673
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â61
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  715
                  598
                  468
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  765
                  715
                  598
               
               
                  3200
                  Obligated balance, end of year
                  715
                  598
                  468
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  503
                  489
                  528
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  134
                  117
               
               
                  4101
                  Outlays from mandatory balances
                  517
                  615
                  556
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  517
                  749
                  673
               
               
                  4180
                  Budget authority, net (total)
                  503
                  489
                  528
               
               
                  4190
                  Outlays, net (total)
                  517
                  749
                  673
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  503
                  489
                  528
               
               
                  
                  Outlays
                  517
                  749
                  673
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  525
               
               
                  
                  Outlays
                  
                  
                  25
               
               
                  Total:
               
               
                  
                  Budget Authority
                  503
                  489
                  1,053
               
               
                  
                  Outlays
                  517
                  749
                  698
               
               
                  
                     
                  
               
            
         
      
      
         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 approximately $9 million for activities authorized by Section 203 and $130 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
                  2013 actual
                  2014 est.
                  2015 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 - Emergency services for undocumented aliens
                  
                  7
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid Integrity Program
                  16
                  117
                  63
               
               
                  41.0
                  Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
                  87
                  434
                  434
               
               
                  41.0
                  Grants, subsidies, and contributions - MFP evaluations and technical support
                  344
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                  1
                  6
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration
                  34
                  30
                  19
               
               
                  41.0
                  Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid
                  
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration
                  14
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid
                  23
                  22
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  534
                  632
                  543
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  79
                  90
                  102
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations                                                                                          
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0516â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0012
                  Medicaid integrity program
                  
                  
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  525
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  525
               
               
                  1900
                  Budget authority (total)
                  
                  
                  525
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  525
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  500
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  25
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â25
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  525
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  25
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  525
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  25
               
               
                  
                     
                  
               
            
         
      
         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, [$255,185,000,000] $259,212,000,000.
      
      In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
         Act that were not anticipated in budget estimates, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0580â0â1â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  181,194
                  192,491
                  194,343
               
               
                  0002
                  Part D benefits (Rx Drug)
                  49,900
                  54,599
                  63,342
               
               
                  0003
                  Part D Federal administration (Rx Drug)
                  368
                  373
                  418
               
               
                  0004
                  General Fund Transfers to HI
                  816
                  1,070
                  1,103
               
               
                  0006
                  Federal Bureau of Investigation (HCFAC)
                  128
                  127
                  140
               
               
                  0007
                  Federal payments from taxation of OASDI benefits (HI)
                  14,310
                  18,114
                  20,956
               
               
                  0008
                  Criminal fines (HCFAC)
                  708
                  1,141
                  1,156
               
               
                  0009
                  Civil monetary penalties and damages (HCFAC - DOJ and CMS administration)
                  41
                  32
                  33
               
               
                  0010
                  Asset Forfeiture
                  30
                  27
                  28
               
               
                  0011
                  State Low Income Determinations
                  
                  
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  247,495
                  267,974
                  281,525
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  6,652
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  234,082
                  255,185
                  259,212
               
               
                  1200
                  Appropriation (indefinite, permanent)
                  14,310
                  18,114
                  20,956
               
               
                  1200
                  Appropriation (HCFAC for FBI)
                  128
                  127
                  140
               
               
                  1200
                  Appropriation (indefinite for HCFAC)
                  780
                  1,200
                  1,217
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  249,300
                  274,626
                  281,525
               
               
                  1930
                  Total budgetary resources available
                  249,300
                  274,626
                  288,177
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1,805
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  6,652
                  6,652
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  5,277
                  5,049
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  247,495
                  267,974
                  281,525
               
               
                  3011
                  Obligations incurred, expired accounts
                  206
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â242,424
                  â268,202
                  â281,525
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5,277
                  5,049
                  5,049
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  5,277
                  5,049
               
               
                  3200
                  Obligated balance, end of year
                  5,277
                  5,049
                  5,049
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  249,300
                  274,626
                  281,525
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  242,318
                  263,017
                  281,525
               
               
                  4101
                  Outlays from mandatory balances
                  106
                  5,185
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  242,424
                  268,202
                  281,525
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â18
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  249,300
                  274,626
                  281,525
               
               
                  4170
                  Outlays, net (mandatory)
                  242,406
                  268,202
                  281,525
               
               
                  4180
                  Budget authority, net (total)
                  249,300
                  274,626
                  281,525
               
               
                  4190
                  Outlays, net (total)
                  242,406
                  268,202
                  281,525
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  249,300
                  274,626
                  281,525
               
               
                  
                  Outlays
                  242,406
                  268,202
                  281,525
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  
                  â60
               
               
                  
                  Outlays
                  
                  
                  â60
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,181
               
               
                  
                  Outlays
                  
                  
                  â1,181
               
               
                  Total:
               
               
                  
                  Budget Authority
                  249,300
                  274,626
                  280,284
               
               
                  
                  Outlays
                  242,406
                  268,202
                  280,284
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  246,184
                  266,404
                  279,864
               
               
                  42.0
                  Insurance claims and indemnities
                  228
                  204
                  187
               
               
                  94.0
                  Financial transfers (Federal admin)
                  1,083
                  1,366
                  1,474
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  247,495
                  267,974
                  281,525
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â60
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite annual)
                  
                  
                  â60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â60
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â60
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â60
               
               
                  3020
                  Outlays (gross)
                  
                  
                  60
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â60
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â60
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â60
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â60
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â700
               
               
                  0002
                  Part D benefits (Rx Drug)
                  
                  
                  â481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â1,181
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â1,181
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â1,181
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,181
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â1,181
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,181
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,181
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,181
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,181
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,181
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement Organizations                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  QIO contracts
                  372
                  1,272
                  334
               
               
                  0002
                  QIO support contracts
                  
                  377
                  391
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  372
                  1,649
                  725
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  55
                  1,649
                  725
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  404
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  459
                  1,649
                  725
               
               
                  1930
                  Total budgetary resources available
                  459
                  1,649
                  725
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â87
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  765
                  626
                  626
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  372
                  1,649
                  725
               
               
                  3011
                  Obligations incurred, expired accounts
                  17
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â512
                  â1,649
                  â725
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  626
                  626
                  626
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,100
                  â1,060
                  â1,060
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â404
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  444
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,060
                  â1,060
                  â1,060
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â335
                  â434
                  â434
               
               
                  3200
                  Obligated balance, end of year
                  â434
                  â434
                  â434
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  459
                  1,649
                  725
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  74
                  1,069
                  254
               
               
                  4101
                  Outlays from mandatory balances
                  438
                  580
                  471
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  512
                  1,649
                  725
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Baseline Program [Text]
                  â499
                  â1,649
                  â725
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â404
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  444
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  40
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  13
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  13
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  28
                  22
                  24
               
               
                  12.1
                  Civilian personnel benefits
                  
                  26
                  26
               
               
                  25.2
                  Other services from non-Federal sources
                  342
                  1,224
                  284
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  377
                  391
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  372
                  1,649
                  725
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0519â0â1â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  153
                  182
                  205
               
               
                  
                     
                  
               
            
         
      
         Program ManagementFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
         XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
         Medicare and Medicaid Services, not to exceed [$3,669,744,000] $4,199,744,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
         as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353
         of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 302
         of the Tax Relief and Health Care Act of 2006; and such sums as may be collected from authorized user fees and the sale of
         data, which shall be credited to this account and remain available until [September 30, 2019] 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 the Secretary is directed to collect fees in fiscal year [2014] 2015 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations
         with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act[: Provided further, That $22,004,000 shall be available for the State high-risk health insurance pool program as authorized by the State High
         Risk Pool Funding Extension Act of 2006]. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  3,127
                  2,888
                  3,003
               
               
                  0002
                  Federal administration
                  788
                  840
                  860
               
               
                  0003
                  State survey and certification
                  372
                  399
                  448
               
               
                  0004
                  Research, demonstrations, and evaluation projects
                  331
                  99
                  60
               
               
                  0006
                  High-risk pool grants
                  42
                  20
                  
               
               
                  0007
                  ARRA Medicare/Medicaid HIT
                  131
                  130
                  138
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  4,791
                  4,376
                  4,509
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,791
                  4,376
                  4,509
               
               
                  0801
                  Clinical laboratory improvement amendments
                  56
                  46
                  50
               
               
                  0802
                  Sale of data
                  16
                  7
                  7
               
               
                  0803
                  Coordination of benefits
                  15
                  1
                  30
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  85
                  70
                  71
               
               
                  0805
                  Provider enrollment
                  16
                  27
                  28
               
               
                  0806
                  Recovery audit contractors
                  455
                  763
                  750
               
               
                  0807
                  Other reimbursable program activity
                  37
                  
                  
               
               
                  0808
                  Marketplace User Fees
                  
                  200
                  1,159
               
               
                  0810
                  Risk Adjustment Administrative Expenses
                  
                  
                  20
               
               
                  0811
                  Risk Corridors
                  
                  
                  5,450
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  680
                  1,114
                  7,565
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  5,471
                  5,490
                  12,074
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,297
                  837
                  686
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  190
                  
                  
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  
                  â10
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,314
                  827
                  686
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other accts [75â9915]
                  114
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  114
                  
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  253
                  253
                  193
               
               
                  1221
                  Appropriations transferred from other accts [75â0116]
                  454
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â213
                  â18
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  494
                  235
                  193
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2,066
                  3,960
                  9,657
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2,257
                  
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  
                  4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,323
                  3,964
                  9,657
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  149
                  1,234
                  2,115
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â42
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  
                  1
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  
                  â85
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  107
                  1,150
                  2,115
               
               
                  1900
                  Budget authority (total)
                  5,038
                  5,349
                  11,965
               
               
                  1930
                  Total budgetary resources available
                  6,352
                  6,176
                  12,651
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â44
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  837
                  686
                  577
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3,436
                  4,197
                  3,525
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  5,471
                  5,490
                  12,074
               
               
                  3011
                  Obligations incurred, expired accounts
                  63
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â4,578
                  â6,162
                  â12,279
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â17
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â178
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,197
                  3,525
                  3,320
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â4,252
                  â4,097
                  â4,097
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,215
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,370
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â4,097
                  â4,097
                  â4,097
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â816
                  100
                  â572
               
               
                  3200
                  Obligated balance, end of year
                  100
                  â572
                  â777
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,437
                  3,964
                  9,657
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,109
                  3,964
                  9,657
               
               
                  4011
                  Outlays from discretionary balances
                  2,035
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,144
                  3,964
                  9,657
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,598
                  â3,953
                  â4,200
               
               
                  4033
                  Non-Federal sources
                  â617
                  â11
                  â5,457
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,215
                  â3,964
                  â9,657
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,257
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,149
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â108
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  114
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â71
                  
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  601
                  1,385
                  2,308
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7
                  1,153
                  2,118
               
               
                  4101
                  Outlays from mandatory balances
                  427
                  1,045
                  504
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  434
                  2,198
                  2,622
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â184
                  â48
                  â6
               
               
                  4123
                  Non-Federal sources
                  â25
                  â1,102
                  â2,109
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â209
                  â1,150
                  â2,115
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  42
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  60
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  102
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  494
                  235
                  193
               
               
                  4170
                  Outlays, net (mandatory)
                  225
                  1,048
                  507
               
               
                  4180
                  Budget authority, net (total)
                  608
                  235
                  193
               
               
                  4190
                  Outlays, net (total)
                  154
                  1,048
                  507
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unavailable balance, SOY: Offsetting collections
                  
                  
                  80
               
               
                  5091
                  Unavailable balance, EOY: Offsetting collections
                  
                  80
                  80
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  608
                  235
                  193
               
               
                  
                  Outlays
                  154
                  1,048
                  507
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  401
               
               
                  
                  Outlays
                  
                  
                  6
               
               
                  Total:
               
               
                  
                  Budget Authority
                  608
                  235
                  594
               
               
                  
                  Outlays
                  154
                  1,048
                  513
               
               
                  
                     
                  
               
            
         
      
      
         Program management activities include funding for program operations, survey and certification, 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  465
                  473
                  507
               
               
                  11.3
                  Other than full-time permanent
                  14
                  10
                  11
               
               
                  11.5
                  Other personnel compensation
                  2
                  8
                  8
               
               
                  11.7
                  Military personnel
                  11
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  492
                  506
                  541
               
               
                  12.1
                  Civilian personnel benefits
                  147
                  136
                  152
               
               
                  12.2
                  Military personnel benefits
                  6
                  8
                  8
               
               
                  21.0
                  Travel and transportation of persons
                  5
                  7
                  7
               
               
                  22.0
                  Transportation of things
                  1
                  
                  
               
               
                  23.1
                  Rental payments to GSA
                  8
                  8
                  8
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  47
                  
                  
               
               
                  24.0
                  Printing and reproduction
                  39
                  4
                  4
               
               
                  25.1
                  Advisory and assistance services
                  49
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  2,703
                  2,399
                  2,271
               
               
                  25.3
                  Other goods and services from Federal sources
                  70
                  11
                  10
               
               
                  25.4
                  Operation and maintenance of facilities
                  6
                  
                  
               
               
                  25.5
                  Research and development contracts
                  13
                  20
                  16
               
               
                  25.6
                  Medical care
                  704
                  1,162
                  1,425
               
               
                  25.7
                  Operation and maintenance of equipment
                  8
                  
                  
               
               
                  26.0
                  Supplies and materials
                  2
                  1
                  1
               
               
                  31.0
                  Equipment
                  3
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  201
                  67
                  19
               
               
                  42.0
                  Insurance claims and indemnities
                  287
                  47
                  47
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,791
                  4,376
                  4,509
               
               
                  99.0
                  Reimbursable obligations
                  680
                  1,114
                  7,565
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  5,471
                  5,490
                  12,074
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â0â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4,551
                  4,379
                  4,574
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  150
                  159
                  190
               
               
                  1101
                  Direct military average strength employment
                  138
                  163
                  164
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  105
                  112
                  125
               
               
                  
                     
                  
               
            
         
      
         Program Management                                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  
                  
                  430
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  
                  
                  430
               
               
                  0801
                  Federal Payment Levy Program
                  
                  
                  2
               
               
                  0802
                  Survey and Certification CMP Investment
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  433
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  400
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  400
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  
                  
                  33
               
               
                  1900
                  Budget authority (total)
                  
                  
                  433
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  433
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  433
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â38
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  395
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  395
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  433
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  38
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â30
               
               
                  4124
                  Offsetting governmental collections
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  
                  
                  â32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  
                  401
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  
                  6
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  401
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  6
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  427
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  430
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  433
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0511â4â1â550
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  20
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0515â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and U.S. territories
                  8,972
                  9,514
                  10,388
               
               
                  0002
                  Performance bonus payments
                  345
                  339
                  
               
               
                  0003
                  Child health quality improvement
                  40
                  52
                  11
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  9,357
                  9,905
                  10,399
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  860
                  282
                  3,207
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  6,094
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  36
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6,990
                  282
                  3,207
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation (CHIPRA Performance Bonus Extension)
                  
                  
                  350
               
               
                  1130
                  Appropriations permanently reduced
                  
                  
                  â3,485
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â3,135
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  17,451
                  19,147
                  21,061
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â6,368
                  â6,317
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  11,083
                  12,830
                  21,061
               
               
                  1900
                  Budget authority (total)
                  11,083
                  12,830
                  17,926
               
               
                  1930
                  Total budgetary resources available
                  18,073
                  13,112
                  21,133
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â8,434
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  282
                  3,207
                  10,734
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,474
                  6,115
                  5,831
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  9,357
                  9,905
                  10,399
               
               
                  3011
                  Obligations incurred, expired accounts
                  17
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â9,469
                  â10,189
                  â10,861
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â36
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â228
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,115
                  5,831
                  5,369
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,474
                  6,115
                  5,831
               
               
                  3200
                  Obligated balance, end of year
                  6,115
                  5,831
                  5,369
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â3,135
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  350
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  11,083
                  12,830
                  21,061
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,466
                  6,300
                  1,100
               
               
                  4101
                  Outlays from mandatory balances
                  6,003
                  3,889
                  9,411
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  9,469
                  10,189
                  10,511
               
               
                  4180
                  Budget authority, net (total)
                  11,083
                  12,830
                  17,926
               
               
                  4190
                  Outlays, net (total)
                  9,469
                  10,189
                  10,861
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  11,083
                  12,830
                  17,926
               
               
                  
                  Outlays
                  9,469
                  10,189
                  10,861
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  10
               
               
                  
                  Outlays
                  
                  
                  10
               
               
                  Total:
               
               
                  
                  Budget Authority
                  11,083
                  12,830
                  17,936
               
               
                  
                  Outlays
                  9,469
                  10,189
                  10,871
               
               
                  
                     
                  
               
            
         
      
      
         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.
         
      
         Children's Health Insurance Fund                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0515â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0004
                  Express Lane Eligibility
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  10
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  10
               
               
                  1900
                  Budget authority (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
               
               
                  
                     
                  
               
            
         
      
         Center for Medicare and Medicaid Innovation                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Administration
                  97
                  213
                  216
               
               
                  0002
                  Innovation Activities
                  856
                  1,424
                  1,306
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  953
                  1,637
                  1,522
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  9,130
                  8,180
                  6,543
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  9,133
                  8,180
                  6,543
               
               
                  1930
                  Total budgetary resources available
                  9,133
                  8,180
                  6,543
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  8,180
                  6,543
                  5,021
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  647
                  941
                  1,524
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  953
                  1,637
                  1,522
               
               
                  3020
                  Outlays (gross)
                  â656
                  â1,054
                  â1,444
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  941
                  1,524
                  1,602
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  647
                  941
                  1,524
               
               
                  3200
                  Obligated balance, end of year
                  941
                  1,524
                  1,602
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  656
                  1,054
                  1,444
               
               
                  4190
                  Outlays, net (total)
                  656
                  1,054
                  1,444
               
               
                  
                     
                  
               
            
         
      
      
         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 years 2011 through 2019.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  26
                  45
                  48
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  14
                  15
               
               
                  25.2
                  Other services from non-Federal sources
                  282
                  485
                  450
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  635
                  1,091
                  1,006
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  953
                  1,637
                  1,522
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0522â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  258
                  412
                  443
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  3
               
               
                  
                  Receipts:
               
               
                  0240
                  Interest, Child Enrollment Contingency Fund
                  3
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  3
                  3
                  3
               
               
                  
                  Appropriations:
               
               
                  0500
                  Child Enrollment Contingency Fund
                  
                  
                  2,099
               
               
                  0501
                  Child Enrollment Contingency Fund
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â3
                  
                  2,099
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  3
                  2,102
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5551â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and US Territories
                  
                  100
                  100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  100
                  100
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,093
                  2,096
                  2,099
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1134
                  Unobligated balance precluded from obligation
                  
                  
                  â2,099
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â2,099
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  103
                  100
               
               
                  1201
                  Appropriation (special or trust fund)
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  3
                  103
                  100
               
               
                  1900
                  Budget authority (total)
                  3
                  103
                  â1,999
               
               
                  1930
                  Total budgetary resources available
                  2,096
                  2,199
                  100
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2,096
                  2,099
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  26
                  12
                  12
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  100
                  100
               
               
                  3020
                  Outlays (gross)
                  â14
                  â100
                  â100
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12
                  12
                  12
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  26
                  12
                  12
               
               
                  3200
                  Obligated balance, end of year
                  12
                  12
                  12
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â2,099
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  3
                  103
                  100
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  14
                  100
                  100
               
               
                  4180
                  Budget authority, net (total)
                  3
                  103
                  â1,999
               
               
                  4190
                  Outlays, net (total)
                  14
                  100
                  100
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  2,096
                  2,098
                  
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  2,098
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Incentive payments to hospitals
                  3,385
                  6,213
                  1,436
               
               
                  0802
                  Incentive payments to eligible professionals
                  2,674
                  3,450
                  710
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  6,059
                  9,663
                  2,146
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,070
                  1,871
                  1,871
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected from the HI Trust Fund
                  3,519
                  6,213
                  1,436
               
               
                  1800
                  Collected from the SMI Trust Fund
                  2,797
                  3,450
                  710
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  544
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  6,860
                  9,663
                  2,146
               
               
                  1930
                  Total budgetary resources available
                  7,930
                  11,534
                  4,017
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,871
                  1,871
                  1,871
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  448
                  305
                  305
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  6,059
                  9,663
                  2,146
               
               
                  3020
                  Outlays (gross)
                  â6,202
                  â9,663
                  â2,146
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  305
                  305
                  305
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,898
                  â2,442
                  â2,442
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â544
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2,442
                  â2,442
                  â2,442
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â1,450
                  â2,137
                  â2,137
               
               
                  3200
                  Obligated balance, end of year
                  â2,137
                  â2,137
                  â2,137
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  6,860
                  9,663
                  2,146
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  4,685
                  8,363
                  1,696
               
               
                  4101
                  Outlays from mandatory balances
                  1,517
                  1,300
                  450
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6,202
                  9,663
                  2,146
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â6,316
                  â9,663
                  â2,146
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â544
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â114
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â114
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Rate Review Grants                                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0112â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Premium rate review grants
                  70
                  31
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  70
                  31
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  90
                  29
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  9
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  99
                  31
                  
               
               
                  1930
                  Total budgetary resources available
                  99
                  31
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  29
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  127
                  162
                  111
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  70
                  31
                  
               
               
                  3020
                  Outlays (gross)
                  â26
                  â80
                  â50
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â9
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  162
                  111
                  61
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  127
                  162
                  111
               
               
                  3200
                  Obligated balance, end of year
                  162
                  111
                  61
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  26
                  80
                  50
               
               
                  4190
                  Outlays, net (total)
                  26
                  80
                  50
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  1,587
                  367
                  
               
               
                  0801
                  Premiums from Fallback States
                  183
                  75
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,770
                  442
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,832
                  367
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  93
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,925
                  367
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  212
                  75
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  212
                  75
                  
               
               
                  1900
                  Budget authority (total)
                  212
                  75
                  
               
               
                  1930
                  Total budgetary resources available
                  2,137
                  442
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  367
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,261
                  585
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,770
                  442
                  
               
               
                  3020
                  Outlays (gross)
                  â2,353
                  â1,027
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â93
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  585
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,261
                  585
                  
               
               
                  3200
                  Obligated balance, end of year
                  585
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  212
                  75
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  183
                  75
                  
               
               
                  4101
                  Outlays from mandatory balances
                  2,170
                  952
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,353
                  1,027
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â212
                  â75
                  
               
               
                  4190
                  Outlays, net (total)
                  2,141
                  952
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 2015 President's Budget obligation and outlays projections are based on policy assumptions to manage
            costs in the program to the $5 billion appropriation.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  4
                  3
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  20
                  16
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,563
                  348
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1,587
                  367
                  
               
               
                  99.0
                  Reimbursable obligations
                  183
                  75
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,770
                  442
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0113â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  12
                  14
                  
               
               
                  
                     
                  
               
            
         
      
         Early Retiree Reinsurance Program                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Subsidies for early retirees
                  39
                  7
                  
               
               
                  0002
                  Administration
                  21
                  12
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  60
                  19
                  1
               
               
                  0801
                  Reimbursable program activity
                  21
                  33
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  81
                  52
                  1
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  75
                  20
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  80
                  20
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  21
                  33
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  21
                  33
                  
               
               
                  1900
                  Budget authority (total)
                  21
                  33
                  
               
               
                  1930
                  Total budgetary resources available
                  101
                  53
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  20
                  1
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  23
                  19
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  81
                  52
                  1
               
               
                  3020
                  Outlays (gross)
                  â80
                  â71
                  â1
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  19
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  23
                  19
                  
               
               
                  3200
                  Obligated balance, end of year
                  19
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  21
                  33
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  21
                  33
                  
               
               
                  4101
                  Outlays from mandatory balances
                  59
                  38
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  80
                  71
                  1
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â10
                  â17
                  
               
               
                  4123
                  Non-Federal sources
                  â11
                  â16
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â21
                  â33
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  59
                  38
                  1
               
               
                  4190
                  Outlays, net (total)
                  59
                  38
                  1
               
               
                  
                     
                  
               
            
         
      
      
         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. By statute, ERRP sunsets on January 1, 2014 and is no longer providing reimbursements to plan sponsors. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  12
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  19
                  
                  1
               
               
                  42.0
                  Insurance claims and indemnities
                  39
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  60
                  19
                  1
               
               
                  99.0
                  Reimbursable obligations
                  21
                  33
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  81
                  52
                  1
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0114â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  11
                  8
                  
               
               
                  
                     
                  
               
            
         
      
         Affordable Insurance Exchange Grants                                                                                     
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Planning and establishment grants
                  2,107
                  1,268
                  785
               
               
                  0002
                  Administration
                  41
                  51
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,148
                  1,319
                  836
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,194
                  1,414
                  836
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â46
                  â95
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  2,148
                  1,319
                  836
               
               
                  1930
                  Total budgetary resources available
                  2,148
                  1,319
                  836
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,899
                  3,016
                  1,888
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,148
                  1,319
                  836
               
               
                  3011
                  Obligations incurred, expired accounts
                  159
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â963
                  â2,447
                  â1,899
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â227
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,016
                  1,888
                  825
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,899
                  3,016
                  1,888
               
               
                  3200
                  Obligated balance, end of year
                  3,016
                  1,888
                  825
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,148
                  1,319
                  836
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  100
                  659
                  418
               
               
                  4101
                  Outlays from mandatory balances
                  863
                  1,788
                  1,481
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  963
                  2,447
                  1,899
               
               
                  4180
                  Budget authority, net (total)
                  2,148
                  1,319
                  836
               
               
                  4190
                  Outlays, net (total)
                  963
                  2,447
                  1,899
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  10
                  10
                  10
               
               
                  25.2
                  Other services from non-Federal sources
                  31
                  41
                  41
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,107
                  1,268
                  785
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,148
                  1,319
                  836
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0115â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  56
                  65
                  76
               
               
                  
                     
                  
               
            
         
      
         Risk Adjustment Program Payments                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5733â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  0200
                  Receipts, Risk Adjustment Program
                  
                  
                  3,378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  
                  
                  3,378
               
               
                  
                  Appropriations:
               
               
                  0500
                  Risk Adjustment Program Payments
                  
                  
                  â3,378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5733â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  3,378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  3,378
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  3,378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  3,378
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  3,378
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  3,378
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â3,378
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  3,378
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  3,378
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  3,378
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  3,378
               
               
                  
                     
                  
               
            
         
      
      
         Section 1343 of the Affordable Care Act (P.L. 111â148) established a permanent risk adjustment program for non-grandfathered
            plans in the individual and small group markets. Charges are collected from health insurance issuers that enroll healthier
            than average enrollees and payments are made to issuers that enroll sicker than average enrollees. Risk adjustment may be
            operated by a State, or by the Federal government in the event a State chooses not to operate risk adjustment. Payments and
            charges are made in the year following the plan year for which they are calculated.
         
      
         Transitional Reinsurance Program                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5735â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  0200
                  Contributions, Transitional Reinsurance Program
                  
                  
                  10,020
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  
                  
                  10,020
               
               
                  
                  Appropriations:
               
               
                  0500
                  Transitional Reinsurance Program
                  
                  
                  â10,020
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5735â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Transitional reinsurance payments
                  
                  
                  10,000
               
               
                  0002
                  Administrative expenses
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  10,020
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  10,020
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  10,020
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  10,020
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  10,020
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â10,020
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  10,020
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  10,020
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  10,020
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  10,020
               
               
                  
                     
                  
               
            
         
      
      
         Section 1341 of the Affordable Care Act (P.L. 111â148) established a transitional, temporary, three-year reinsurance program
            to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015, and 2016. The Centers
            for Medicare & Medicaid Services assesses health insurance issuers and group health plans a per enrollee fee to fund the reinsurance
            contributions, and makes payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold,
            up to a reinsurance cap. Reinsurance collections and payments are made in the year following the plan year for which they
            are applicable.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â5735â0â2â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions - Transitional Reinsurance
                  
                  
                  10,000
               
               
                  41.0
                  Grants, subsidies, and contributions - Administration
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  10,020
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0701
                  Direct loan subsidy
                  2
                  210
                  
               
               
                  0709
                  Administrative expenses
                  8
                  11
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  10
                  221
                  8
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  230
                  9
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other accts [75â0118]
                  253
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  240
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  240
                  230
                  9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  230
                  9
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  7
                  173
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  10
                  221
                  8
               
               
                  3020
                  Outlays (gross)
                  â3
                  â55
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7
                  173
                  171
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  7
                  173
               
               
                  3200
                  Obligated balance, end of year
                  7
                  173
                  171
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  240
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  55
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  3
                  55
                  10
               
               
                  4180
                  Budget authority, net (total)
                  240
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  3
                  55
                  10
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan levels supportable by subsidy budget authority:
               
               
                  115001
                  Startup Loans
                  7
                  116
                  
               
               
                  115002
                  Solvency Loans
                  
                  402
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  115999
                  Total direct loan levels
                  7
                  518
                  
               
               
                  
                  Direct loan subsidy (in percent):
               
               
                  132001
                  Startup Loans
                  37.66
                  35.66
                  0.00
               
               
                  132002
                  Solvency Loans
                  0.00
                  42.08
                  0.00
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  132999
                  Weighted average subsidy rate
                  37.66
                  40.64
                  0.00
               
               
                  
                  Direct loan subsidy budget authority:
               
               
                  133001
                  Startup Loans
                  2
                  41
                  
               
               
                  133002
                  Solvency Loans
                  
                  169
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  133999
                  Total subsidy budget authority
                  2
                  210
                  
               
               
                  
                  Direct loan subsidy outlays:
               
               
                  134001
                  Startup Loans
                  1
                  43
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  134999
                  Total subsidy outlays
                  1
                  43
                  
               
               
                  
                  Direct loan downward reestimates:
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  2
                  12
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  5
                  4
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  6
                  5
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2
                  210
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  10
                  221
                  8
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0524â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  18
                  18
                  16
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Account                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0701
                  Direct loan subsidy
                  122
                  
                  
               
               
                  0703
                  Subsidy for modifications of direct loans
                  5
                  
                  
               
               
                  0705
                  Reestimates of direct loan subsidy
                  3
                  18
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  
                  1
                  
               
               
                  0709
                  Administrative expenses
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  130
                  19
                  1
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,659
                  8
                  8
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,667
                  8
                  8
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3
                  19
                  
               
               
                  1220
                  Appropriations transferred to other accts [75â0524]
                  â253
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2,279
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  â2,529
                  19
                  
               
               
                  1930
                  Total budgetary resources available
                  138
                  27
                  8
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  8
                  8
                  7
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  703
                  548
                  326
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  130
                  19
                  1
               
               
                  3020
                  Outlays (gross)
                  â277
                  â241
                  â147
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  548
                  326
                  180
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  703
                  548
                  326
               
               
                  3200
                  Obligated balance, end of year
                  548
                  326
                  180
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  â2,529
                  19
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  19
                  
               
               
                  4101
                  Outlays from mandatory balances
                  274
                  222
                  147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  277
                  241
                  147
               
               
                  4180
                  Budget authority, net (total)
                  â2,529
                  19
                  
               
               
                  4190
                  Outlays, net (total)
                  277
                  241
                  147
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0118â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan levels supportable by subsidy budget authority:
               
               
                  115002
                  Startup Loans
                  37
                  
                  
               
               
                  115003
                  Solvency
                  257
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  115999
                  Total direct loan levels
                  294
                  
                  
               
               
                  
                  Direct loan subsidy (in percent):
               
               
                  132002
                  Startup Loans
                  37.66
                  0.00
                  0.00
               
               
                  132003
                  Solvency
                  41.90
                  0.00
                  0.00
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  132999
                  Weighted average subsidy rate
                  41.37
                  0.00
                  0.00
               
               
                  
                  Direct loan subsidy budget authority:
               
               
                  133002
                  Startup Loans
                  14
                  
                  
               
               
                  133003
                  Solvency
                  108
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  133999
                  Total subsidy budget authority
                  122
                  
                  
               
               
                  
                  Direct loan subsidy outlays:
               
               
                  134002
                  Startup Loans
                  71
                  14
                  
               
               
                  134003
                  Solvency
                  195
                  205
                  147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  134999
                  Total subsidy outlays
                  266
                  219
                  147
               
               
                  
                  Direct loan upward reestimates:
               
               
                  135002
                  Startup Loans
                  3
                  
                  
               
               
                  135003
                  Solvency
                  
                  19
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total upward reestimate budget authority
                  3
                  19
                  
               
               
                  
                  Direct loan downward reestimates:
               
               
                  137002
                  Startup Loans
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  137999
                  Total downward reestimate budget authority
                  
                  â6
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  4
                  3
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  130
                  19
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  130
                  19
                  1
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0710
                  Direct loan obligations
                  295
                  
                  
               
               
                  0713
                  Payment of interest to Treasury
                  22
                  35
                  45
               
               
                  0742
                  Downward reestimate paid to receipt account
                  
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  317
                  41
                  45
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,228
                  1
                  1
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â2,228
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  19
                  1
                  1
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  386
                  24
                  27
               
               
                  1422
                  Borrowing authority applied to repay debt
                  â236
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1440
                  Borrowing authority, mandatory (total)
                  150
                  24
                  27
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  296
                  255
                  165
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â147
                  â219
                  â147
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â19
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  149
                  17
                  18
               
               
                  1900
                  Financing authority (total)
                  299
                  41
                  45
               
               
                  1930
                  Total budgetary resources available
                  318
                  42
                  46
               
               
                  
                  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
                  1,601
                  1,243
                  739
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  317
                  41
                  45
               
               
                  3020
                  Financing disbursements (gross)
                  â656
                  â545
                  â379
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,243
                  739
                  405
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â692
                  â545
                  â326
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  147
                  219
                  147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â545
                  â326
                  â179
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  909
                  698
                  413
               
               
                  3200
                  Obligated balance, end of year
                  698
                  413
                  226
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Financing authority, gross
                  299
                  41
                  45
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Financing disbursements, gross
                  656
                  545
                  379
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â269
                  â238
                  â147
               
               
                  4122
                  Interest on uninvested funds
                  â17
                  â17
                  â18
               
               
                  4123
                  Non-Federal sources
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross financing auth and disbursements (total)
                  â296
                  â255
                  â165
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  147
                  219
                  147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Financing authority, net (mandatory)
                  150
                  5
                  27
               
               
                  4170
                  Financing disbursements, net (mandatory)
                  360
                  290
                  214
               
               
                  4180
                  Financing authority, net (total)
                  150
                  5
                  27
               
               
                  4190
                  Financing disbursements, net (total)
                  360
                  290
                  214
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4418â0â3â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on obligations:
               
               
                  1131
                  Direct loan obligations exempt from limitation
                  295
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1150
                  Total direct loan obligations
                  295
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  90
                  714
                  1,218
               
               
                  1231
                  Disbursements: Direct loan disbursements
                  634
                  504
                  333
               
               
                  1251
                  Repayments: Repayments and prepayments
                  â10
                  
                  
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  714
                  1,218
                  1,551
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2012 actual
                  2013 actual
               
               
                  
                     
                  
               
               
                  
                  Group heading
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  
                  118
               
               
                  
                  Investments in US securities:
               
               
                  1106
                  Receivables, net
                  
                  25
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  90
                  714
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â34
                  â309
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  56
                  405
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  56
                  548
               
               
                  
                  LIABILITIES:
               
               
                  2103
                  Federal liabilities: Debt
                  56
                  548
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  56
                  548
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing Account                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4482â0â3â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0710
                  Direct loan obligations
                  7
                  518
                  
               
               
                  0713
                  Payment of interest to Treasury
                  
                  1
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  7
                  519
                  3
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  5
                  309
                  3
               
               
                  1422
                  Borrowing authority applied to repay debt
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1440
                  Borrowing authority, mandatory (total)
                  4
                  309
                  3
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1
                  43
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  2
                  167
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  3
                  210
                  
               
               
                  1900
                  Financing authority (total)
                  7
                  519
                  3
               
               
                  1930
                  Total budgetary resources available
                  7
                  519
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  5
                  402
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7
                  519
                  3
               
               
                  3020
                  Financing disbursements (gross)
                  â2
                  â122
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5
                  402
                  402
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â2
                  â169
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  â167
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â169
                  â169
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  3
                  233
               
               
                  3200
                  Obligated balance, end of year
                  3
                  233
                  233
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Financing authority, gross
                  7
                  519
                  3
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Financing disbursements, gross
                  2
                  122
                  3
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1
                  â43
                  
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  â167
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Financing authority, net (mandatory)
                  4
                  309
                  3
               
               
                  4170
                  Financing disbursements, net (mandatory)
                  1
                  79
                  3
               
               
                  4180
                  Financing authority, net (total)
                  4
                  309
                  3
               
               
                  4190
                  Financing disbursements, net (total)
                  1
                  79
                  3
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4482â0â3â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on obligations:
               
               
                  1131
                  Direct loan obligations exempt from limitation
                  7
                  518
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1150
                  Total direct loan obligations
                  7
                  518
                  
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  
                  2
                  123
               
               
                  1231
                  Disbursements: Direct loan disbursements
                  2
                  121
                  
               
               
                  1251
                  Repayments: Repayments and prepayments
                  
                  
                  
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  2
                  123
                  123
               
               
                  
                     
                  
               
            
         
      
      
         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.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â4482â0â3â551
                  2012 actual
                  2013 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1401
                  Net value of assets related to post-1991 direct loans receivable: Direct loans receivable, gross
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  
                  2
               
               
                  
                     
                  
               
            
         
      
      Trust Funds
         Federal Hospital Insurance Trust Fund                                                                                    
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  203,744
                  179,985
                  163,016
               
               
                  
                  Adjustments:
               
               
                  0190
                  Rounding adjustment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  203,745
                  179,985
                  163,016
               
               
                  
                  Receipts:
               
               
                  0200
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  192,707
                  200,501
                  211,795
               
               
                  0201
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)- legislative proposal subject to PAYGO
                  
                  7
                  679
               
               
                  0202
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  547
                  556
                  568
               
               
                  0203
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  16,016
                  18,406
                  18,683
               
               
                  0204
                  FHI Trust Fund, Civil Penalties and Damages
                  1,364
                  1,134
                  1,172
               
               
                  0220
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  1
                  2
                  2
               
               
                  0221
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  260
                  246
                  232
               
               
                  0222
                  FHI Trust Fund, Basic Premium, Medicare Advantage- legislative proposal subject to PAYGO
                  
                  
                  â2
               
               
                  0223
                  FHI Trust Fund, Medicare Refunds
                  10,603
                  9,500
                  9,850
               
               
                  0224
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,397
                  3,520
                  3,499
               
               
                  0225
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible- legislative proposal subject to PAYGO
                  
                  
                  â38
               
               
                  0240
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,582
                  3,440
                  3,446
               
               
                  0241
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  596
                  600
                  610
               
               
                  0242
                  FHI Trust Fund, Interest Received by Trust Funds
                  9,888
                  8,855
                  8,275
               
               
                  0243
                  FHI Trust Fund, Interest Received by Trust Funds- legislative proposal not subject to PAYGO
                  
                  
                  72
               
               
                  0244
                  FHI Trust Fund, Taxation on OASDI Benefits
                  14,310
                  18,114
                  20,956
               
               
                  0245
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  
                  127
                  140
               
               
                  0246
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  708
                  1,141
                  1,156
               
               
                  0247
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  14
                  23
                  23
               
               
                  0248
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  30
                  27
                  28
               
               
                  0249
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  29
                  26
                  31
               
               
                  0250
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  110
                  1,299
                  1,104
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0299
                  Total receipts and collections
                  254,162
                  267,524
                  282,281
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  457,907
                  447,509
                  445,297
               
               
                  
                  Appropriations:
               
               
                  0500
                  Federal Hospital Insurance Trust Fund
                  â2,505
                  â2,565
                  â2,711
               
               
                  0501
                  Federal Hospital Insurance Trust Fund
                  132
                  
                  
               
               
                  0502
                  Federal Hospital Insurance Trust Fund
                  â250,116
                  â263,358
                  â278,237
               
               
                  0503
                  Federal Hospital Insurance Trust Fund
                  â23,960
                  â17,016
                  â3,174
               
               
                  0504
                  Federal Hospital Insurance Trust Fund
                  27
                  2
                  
               
               
                  0505
                  Federal Hospital Insurance Trust Fund- legislative proposal not subject to PAYGO
                  
                  
                  480
               
               
                  0506
                  Federal Hospital Insurance Trust Fund- legislative proposal not subject to PAYGO
                  
                  
                  â480
               
               
                  0507
                  Federal Hospital Insurance Trust Fund- legislative proposal subject to PAYGO
                  
                  
                  â340
               
               
                  0508
                  Federal Hospital Insurance Trust Fund- legislative proposal subject to PAYGO
                  
                  
                  2,717
               
               
                  0509
                  Federal Hospital Insurance Trust Fund
                  
                  
                  6
               
               
                  0510
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â6
               
               
                  0511
                  Health Care Fraud and Abuse Control Account
                  â310
                  â294
                  â319
               
               
                  0512
                  Health Care Fraud and Abuse Control Account
                  16
                  
                  
               
               
                  0513
                  Health Care Fraud and Abuse Control Account
                  â1,294
                  â1,313
                  â1,214
               
               
                  0514
                  Health Care Fraud and Abuse Control Account
                  34
                  51
                  
               
               
                  0515
                  Health Care Fraud and Abuse Control Account- legislative proposal not subject to PAYGO
                  
                  
                  552
               
               
                  0516
                  Health Care Fraud and Abuse Control Account- legislative proposal subject to PAYGO
                  
                  
                  â378
               
               
                  0517
                  Health Care Fraud and Abuse Control Account
                  
                  
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â277,976
                  â284,493
                  â283,061
               
               
                  0610
                  Federal Hospital Insurance Trust Fund
                  2
                  
                  
               
               
                  0620
                  Federal Hospital Insurance Trust Fund
                  52
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  179,985
                  163,016
                  162,236
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  269,780
                  272,604
                  279,185
               
               
                  0002
                  HIT Incentive Payments
                  3,366
                  6,213
                  1,436
               
               
                  0003
                  Administration, HI
                  2,904
                  2,730
                  2,860
               
               
                  0004
                  Quality improvement organizations, HI
                  459
                  1,319
                  580
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  276,509
                  282,866
                  284,061
               
               
                  0801
                  Reimbursable program activity
                  439
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  276,948
                  282,866
                  284,061
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  71
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  141
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  â52
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  87
                  
                  71
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  2,505
                  2,565
                  2,711
               
               
                  1132
                  Appropriations temporarily reduced
                  â132
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,373
                  2,565
                  2,711
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  250,116
                  263,358
                  278,237
               
               
                  1203
                  Appropriation (previously unavailable)
                  23,960
                  17,016
                  3,174
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â27
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  274,049
                  280,372
                  281,411
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  440
                  
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  439
                  
                  
               
               
                  1900
                  Budget authority (total)
                  276,861
                  282,937
                  284,122
               
               
                  1930
                  Total budgetary resources available
                  276,948
                  282,937
                  284,193
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  71
                  132
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1950
                  Other balances withdrawn and returned to unappropriated receipts
                  2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  24,209
                  24,941
                  24,922
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  276,948
                  282,866
                  284,061
               
               
                  3020
                  Outlays (gross)
                  â276,075
                  â282,885
                  â284,064
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â141
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  24,941
                  24,922
                  24,919
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  24,208
                  24,941
                  24,922
               
               
                  3200
                  Obligated balance, end of year
                  24,941
                  24,922
                  24,919
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,373
                  2,565
                  2,711
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,599
                  1,699
                  1,793
               
               
                  4011
                  Outlays from discretionary balances
                  857
                  747
                  831
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,456
                  2,446
                  2,624
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  274,488
                  280,372
                  281,411
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  273,031
                  253,958
                  254,032
               
               
                  4101
                  Outlays from mandatory balances
                  588
                  26,481
                  27,408
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  273,619
                  280,439
                  281,440
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â440
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  274,049
                  280,372
                  281,411
               
               
                  4170
                  Outlays, net (mandatory)
                  273,179
                  280,439
                  281,440
               
               
                  4180
                  Budget authority, net (total)
                  276,422
                  282,937
                  284,122
               
               
                  4190
                  Outlays, net (total)
                  275,635
                  282,885
                  284,064
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  228,292
                  206,010
                  188,994
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  206,010
                  188,994
                  185,820
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  276,422
                  282,937
                  284,122
               
               
                  
                  Outlays
                  275,635
                  282,885
                  284,064
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â2,377
               
               
                  
                  Outlays
                  
                  
                  â2,377
               
               
                  Total:
               
               
                  
                  Budget Authority
                  276,422
                  282,937
                  281,745
               
               
                  
                  Outlays
                  275,635
                  282,885
                  281,687
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  229,337
                  206,314
                  189,256
               
               
                  
                  Adjustments:
               
               
                  0190
                  Rounding adjustment
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Total balance, start of year
                  229,340
                  206,314
                  189,256
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1200
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  192,707
                  200,501
                  211,795
               
               
                  1202
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  547
                  556
                  568
               
               
                  1203
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  16,016
                  18,406
                  18,683
               
               
                  1204
                  FHI Trust Fund, Civil Penalties and Damages
                  1,364
                  1,134
                  1,172
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1220
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  1
                  2
                  2
               
               
                  1221
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  260
                  246
                  232
               
               
                  1223
                  FHI Trust Fund, Medicare Refunds
                  10,603
                  9,500
                  9,850
               
               
                  1224
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,397
                  3,520
                  3,499
               
               
                  
                  Offsetting receipts (intragovernmental):
               
               
                  1240
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,582
                  3,440
                  3,446
               
               
                  1241
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  596
                  600
                  610
               
               
                  1242
                  FHI Trust Fund, Interest Received by Trust Funds
                  9,888
                  8,855
                  8,275
               
               
                  1244
                  FHI Trust Fund, Taxation on OASDI Benefits
                  14,310
                  18,114
                  20,956
               
               
                  1245
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  
                  127
                  140
               
               
                  1246
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  708
                  1,141
                  1,156
               
               
                  1247
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  14
                  23
                  23
               
               
                  1248
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  30
                  27
                  28
               
               
                  1249
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  29
                  26
                  31
               
               
                  1250
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  110
                  1,299
                  1,104
               
               
                  
                  Offsetting collections:
               
               
                  1280
                  Federal Hospital Insurance Trust Fund
                  440
                  
                  
               
               
                  1299
                  Income under present law
                  254,602
                  267,517
                  281,570
               
               
                  
                  Proposed legislation:
               
               
                  
                  Receipts:
               
               
                  2201
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  7
                  679
               
               
                  
                  Offsetting receipts (proprietary receipts):
               
               
                  2222
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  
                  
                  â2
               
               
                  2225
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â38
               
               
                  
                  Offsetting receipts (intragovernmental):
               
               
                  2243
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  
                  72
               
               
                  2299
                  Income under proposed legislation
                  
                  7
                  711
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total cash income
                  254,602
                  267,524
                  282,281
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  4500
                  Federal Hospital Insurance Trust Fund
                  â276,075
                  â282,885
                  â284,064
               
               
                  4500
                  Health Care Fraud and Abuse Control Account
                  
                  
                  43
               
               
                  4500
                  Health Care Fraud and Abuse Control Account
                  â1,555
                  â1,697
                  â1,576
               
               
                  4599
                  Outgo under current law (-)
                  â277,630
                  â284,582
                  â285,597
               
               
                  
                  Proposed legislation:
               
               
                  5500
                  Federal Hospital Insurance Trust Fund
                  
                  
                  2,377
               
               
                  5500
                  Health Care Fraud and Abuse Control Account
                  
                  
                  â378
               
               
                  5500
                  Health Care Fraud and Abuse Control Account
                  
                  
                  552
               
               
                  5599
                  Outgo under proposed legislation (-)
                  
                  
                  2,551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â277,630
                  â284,582
                  â283,046
               
               
                  
                  Manual Adjustments:
               
               
                  7690
                  Rounding adjustment
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  7699
                  Total adjustments
                  2
                  
                  
               
               
                  
                  Unexpended balance, end of year:
               
               
                  8700
                  Uninvested balance (net), end of year
                  304
                  262
                  2,671
               
               
                  8701
                  Federal Hospital Insurance Trust Fund
                  206,010
                  188,994
                  185,820
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  8799
                  Total balance, end of year
                  206,314
                  189,256
                  188,491
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activities
                  459
                  1,319
                  580
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  273,146
                  272,604
                  279,185
               
               
                  94.0
                  Financial transfers
                  2,904
                  8,943
                  4,296
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  276,509
                  282,866
                  284,061
               
               
                  42.0
                  Allocation Account - reimbursable: Insurance claims and indemnities
                  439
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  276,948
                  282,866
                  284,061
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â6
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  6
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â480
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  480
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â2,392
               
               
                  0003
                  Administration, HI
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  â2,377
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  340
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  
                  
                  â2,717
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â2,377
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â2,377
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â2,377
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â2,377
               
               
                  3020
                  Outlays (gross)
                  
                  
                  2,377
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â2,377
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â2,377
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â2,377
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â2,377
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8005â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â2,392
               
               
                  94.0
                  Financial transfers
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  â2,377
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control AccountIn addition to amounts otherwise available for program integrity and program management, [$293,588,000] $318,588,000,  to remain available through September 30, [2015] 2016, 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 [$207,636,000] $262,344,000 shall be for [the Medicare Integrity Program at the Centers for Medicare and Medicaid Services, including administrative costs, to conduct
         oversight activities for Medicare Advantage under Part C and the Medicare Prescription Drug Program under Part D of the Social
         Security Act and for activities described in section 1893(b) of such Act,] Centers for Medicare and Medicaid Services program integrity activities; of which [$28,122,000] $28,122,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities
         authorized by section 1817(k)(3) of such Act[, of which $29,708,000 shall be for the Medicaid and Children's Health Insurance Program ("CHIP'') program integrity activities,]; and of which [$28,122,000] $28,122,000 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 the report required by section 1817(k)(5) of the Social Security Act for fiscal year [2014] 2015 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and
         CHIP programs for the funds provided by this appropriation. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare integrity program
                  815
                  858
                  882
               
               
                  0002
                  FBI fraud and abuse control
                  132
                  127
                  139
               
               
                  0003
                  Other fraud and abuse control
                  296
                  278
                  301
               
               
                  0004
                  Predictive Modeling
                  22
                  11
                  
               
               
                  0005
                  Undistributed SSA savings
                  
                  â19
                  â108
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  1,265
                  1,255
                  1,214
               
               
                  0101
                  CMS discretionary
                  284
                  238
                  262
               
               
                  0102
                  Other discretionary
                  84
                  56
                  56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total Discretionary
                  368
                  294
                  318
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,633
                  1,549
                  1,532
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  186
                  166
                  173
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  55
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  64
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  250
                  166
                  173
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  310
                  294
                  319
               
               
                  1132
                  Appropriations temporarily reduced
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  294
                  294
                  319
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1,294
                  1,313
                  1,214
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â34
                  â51
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,260
                  1,262
                  1,214
               
               
                  1900
                  Budget authority (total)
                  1,554
                  1,556
                  1,533
               
               
                  1930
                  Total budgetary resources available
                  1,804
                  1,722
                  1,706
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â5
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  166
                  173
                  174
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1951
                  Unobligated balance expiring
                  5
                  
                  
               
               
                  1952
                  Expired unobligated balance, start of year
                  44
                  36
                  44
               
               
                  1953
                  Expired unobligated balance, end of year
                  31
                  44
                  44
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,157
                  1,155
                  1,007
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,633
                  1,549
                  1,532
               
               
                  3020
                  Outlays (gross)
                  â1,555
                  â1,697
                  â1,576
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â64
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,155
                  1,007
                  963
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,157
                  1,155
                  1,007
               
               
                  3200
                  Obligated balance, end of year
                  1,155
                  1,007
                  963
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  294
                  294
                  319
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  106
                  294
                  319
               
               
                  4011
                  Outlays from discretionary balances
                  247
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  353
                  294
                  319
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,260
                  1,262
                  1,214
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  402
                  899
                  800
               
               
                  4101
                  Outlays from mandatory balances
                  800
                  504
                  457
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,202
                  1,403
                  1,257
               
               
                  4180
                  Budget authority, net (total)
                  1,554
                  1,556
                  1,533
               
               
                  4190
                  Outlays, net (total)
                  1,555
                  1,697
                  1,576
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,554
                  1,556
                  1,533
               
               
                  
                  Outlays
                  1,555
                  1,697
                  1,576
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  
                  â43
               
               
                  
                  Outlays
                  
                  
                  â43
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â552
               
               
                  
                  Outlays
                  
                  
                  â552
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  378
               
               
                  
                  Outlays
                  
                  
                  378
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,554
                  1,556
                  1,316
               
               
                  
                  Outlays
                  1,555
                  1,697
                  1,359
               
               
                  
                     
                  
               
            
         
      
      
         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 Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent (CMS)
                  37
                  45
                  51
               
               
                  12.1
                  Civilian personnel benefits (CMS)
                  10
                  13
                  13
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  9
                  12
                  13
               
               
                  25.1
                  Advisory and assistance services (predictive modeling)
                  22
                  11
                  
               
               
                  25.2
                  Other services (CMS/Medicaid)
                  40
                  28
                  28
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  107
                  86
                  90
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  234
                  213
                  228
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/AoA)
                  11
                  10
                  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)
                  15
                  13
                  15
               
               
                  25.3
                  Other goods and services from Government accounts (HHS/FDA)
                  5
                  3
                  3
               
               
                  25.6
                  Medical care  (CMS)
                  1,001
                  998
                  1,040
               
               
                  92.0
                  Undistributed
                  
                  â19
                  â108
               
               
                  94.0
                  Financial transfers (FBI)
                  133
                  127
                  139
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,633
                  1,549
                  1,532
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  358
                  442
                  465
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account                                                                              
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â7â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â43
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â43
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â43
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â43
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  43
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  43
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â43
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â43
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â43
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â43
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â552
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â552
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â552
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â552
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  552
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  552
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  552
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â552
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â552
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â552
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â552
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  CMS program integrity
                  
                  
                  214
               
               
                  0002
                  Other program integrity
                  
                  
                  164
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  378
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  378
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  378
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  378
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â378
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  378
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  378
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  378
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  378
               
               
                  
                     
                  
               
            
         
      
      
         For FY 2015, the Budget proposes $378 million in mandatory funds for the Health Care Fraud and Abuse Control program and proposes
            $319 million through discretionary appropriations. After 2015, 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 2016 to offset the cost of shifting the FY 2014 enacted portion of 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 10 years.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8393â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services (CMS/Medicaid)
                  
                  
                  15
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  
                  
                  80
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  
                  
                  85
               
               
                  25.6
                  Medical care  (CMS)
                  
                  
                  198
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  378
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  41,270
                  37,018
                  42,384
               
               
                  
                  Receipts:
               
               
                  0200
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  3,216
                  2,960
                  3,000
               
               
                  0220
                  Other Proprietary Interest from the Public, FSMI Fund
                  4
                  3
                  3
               
               
                  0221
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  3,224
                  3,633
                  4,270
               
               
                  0222
                  Premiums Collected for Medicare Prescription Drug Account, FSMI- legislative proposal subject to PAYGO
                  
                  
                  â110
               
               
                  0223
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  8,666
                  8,748
                  8,795
               
               
                  0224
                  Payments from States, Medicare Prescription Drug Account, FSMI- legislative proposal subject to PAYGO
                  
                  
                  â80
               
               
                  0225
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  246
                  259
                  265
               
               
                  0226
                  Medicare Refunds, SMI
                  5,248
                  4,400
                  4,500
               
               
                  0227
                  Premiums Collected for the Aged, FSMI Fund
                  51,679
                  55,123
                  57,302
               
               
                  0228
                  Premiums Collected for the Aged, FSMI Fund- legislative proposal subject to PAYGO
                  
                  
                  â203
               
               
                  0229
                  Premiums Collected for the Disabled, FSMI Fund
                  10,091
                  10,094
                  10,285
               
               
                  0230
                  Premiums Collected for the Disabled, FSMI Fund- legislative proposal subject to PAYGO
                  
                  
                  â37
               
               
                  0240
                  Federal Contributions, FSMI Fund
                  176,940
                  192,491
                  194,343
               
               
                  0241
                  Federal Contributions, FSMI Fund- legislative proposal not subject to PAYGO
                  
                  
                  â700
               
               
                  0242
                  Federal Contributions, FSMI Fund
                  
                  
                  â60
               
               
                  0243
                  Interest Received by Trust Fund, FSMI Fund
                  2,511
                  2,786
                  3,274
               
               
                  0244
                  Interest Received by Trust Fund, FSMI Fund- legislative proposal not subject to PAYGO
                  
                  â2
                  
               
               
                  0245
                  Interest Received by Trust Fund, FSMI Fund
                  
                  â34
                  â319
               
               
                  0246
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  
                  6
               
               
                  0247
                  Interest, Medicare Prescription Drug Account, FSMI
                  7
                  8
                  10
               
               
                  0248
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  367
                  373
                  418
               
               
                  0249
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  49,900
                  54,599
                  63,342
               
               
                  0250
                  Federal Contributions for Benefits, Prescription Drug Account, SMI- legislative proposal not subject to PAYGO
                  
                  
                  â481
               
               
                  0251
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0299
                  Total receipts and collections
                  312,100
                  335,442
                  347,824
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  353,370
                  372,460
                  390,208
               
               
                  
                  Appropriations:
               
               
                  0500
                  Federal Supplementary Medical Insurance Trust Fund
                  â3,150
                  â3,007
                  â3,147
               
               
                  0501
                  Federal Supplementary Medical Insurance Trust Fund
                  162
                  
                  
               
               
                  0502
                  Federal Supplementary Medical Insurance Trust Fund
                  â242,531
                  â264,896
                  â269,917
               
               
                  0503
                  Federal Supplementary Medical Insurance Trust Fund
                  â6,793
                  
                  
               
               
                  0504
                  Federal Supplementary Medical Insurance Trust Fund
                  7
                  1
                  
               
               
                  0505
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  11,949
                  14,722
               
               
                  0506
                  Federal Supplementary Medical Insurance Trust Fund- legislative proposal not subject to PAYGO
                  
                  
                  1,181
               
               
                  0507
                  Federal Supplementary Medical Insurance Trust Fund- legislative proposal not subject to PAYGO
                  
                  â365
                  â1,941
               
               
                  0508
                  Federal Supplementary Medical Insurance Trust Fund- legislative proposal subject to PAYGO
                  
                  
                  1,101
               
               
                  0509
                  Federal Supplementary Medical Insurance Trust Fund- legislative proposal subject to PAYGO
                  
                  
                  â176
               
               
                  0510
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  34
                  379
               
               
                  0511
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â6,214
                  â14,036
               
               
                  0512
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â348
                  â334
                  â344
               
               
                  0513
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  20
                  
                  
               
               
                  0514
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â63,698
                  â67,244
                  â76,406
               
               
                  0515
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund- legislative proposal subject to PAYGO
                  
                  
                  671
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0599
                  Total appropriations
                  â316,331
                  â330,076
                  â347,913
               
               
                  0610
                  Federal Supplementary Medical Insurance Trust Fund
                  1
                  
                  
               
               
                  0620
                  Federal Supplementary Medical Insurance Trust Fund
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  37,018
                  42,384
                  42,295
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  245,396
                  248,693
                  254,328
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  477
                  390
                  
               
               
                  0003
                  HIT Incentive Payments
                  3,656
                  3,450
                  640
               
               
                  0004
                  Administration, SMI
                  2,880
                  3,090
                  3,229
               
               
                  0005
                  Quality Improvement Organizations, SMI
                  14
                  330
                  145
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  252,423
                  255,953
                  258,342
               
               
                  0801
                  Reimbursable program activity
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  252,434
                  255,953
                  258,342
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  97
                  
                  
               
               
                  1026
                  Adjustment for change in allocation of trust fund limitation or foreign exchange valuation
                  22
                  
                  
               
               
                  1029
                  Other balances withdrawn
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  118
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  3,150
                  3,007
                  3,147
               
               
                  1132
                  Appropriations temporarily reduced
                  â162
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,988
                  3,007
                  3,147
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  242,531
                  264,896
                  269,917
               
               
                  1203
                  Appropriation (previously unavailable)
                  6,793
                  
                  
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â7
                  â1
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  â11,949
                  â14,722
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  249,317
                  252,946
                  255,195
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  11
                  
                  
               
               
                  1900
                  Budget authority (total)
                  252,316
                  255,953
                  258,342
               
               
                  1930
                  Total budgetary resources available
                  252,434
                  255,953
                  258,342
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1950
                  Other balances withdrawn and returned to unappropriated receipts
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  24,404
                  24,692
                  24,835
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  252,434
                  255,953
                  258,342
               
               
                  3020
                  Outlays (gross)
                  â252,049
                  â255,810
                  â258,223
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â97
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  24,692
                  24,835
                  24,954
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  24,404
                  24,692
                  24,835
               
               
                  3200
                  Obligated balance, end of year
                  24,692
                  24,835
                  24,954
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,988
                  3,007
                  3,147
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,666
                  1,643
                  1,710
               
               
                  4011
                  Outlays from discretionary balances
                  1,177
                  1,158
                  1,299
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,843
                  2,801
                  3,009
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  249,328
                  252,946
                  255,195
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  248,293
                  231,056
                  230,102
               
               
                  4101
                  Outlays from mandatory balances
                  913
                  21,953
                  25,112
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  249,206
                  253,009
                  255,214
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â11
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  252,305
                  255,953
                  258,342
               
               
                  4190
                  Outlays, net (total)
                  252,038
                  255,810
                  258,223
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  69,324
                  67,385
                  72,639
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  67,385
                  72,639
                  72,738
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  252,305
                  255,953
                  258,342
               
               
                  
                  Outlays
                  252,038
                  255,810
                  258,223
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  6,180
                  13,657
               
               
                  
                  Outlays
                  
                  6,180
                  13,657
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  365
                  760
               
               
                  
                  Outlays
                  
                  365
                  760
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â925
               
               
                  
                  Outlays
                  
                  
                  â925
               
               
                  Total:
               
               
                  
                  Budget Authority
                  252,305
                  262,498
                  271,834
               
               
                  
                  Outlays
                  252,038
                  262,355
                  271,715
               
               
                  
                     
                  
               
            
         
      
      
         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 who need the subsidy
            the least.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  71,728
                  69,818
                  75,309
               
               
                  
                  Adjustments:
               
               
                  0191
                  Rounding adjustment
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Total balance, start of year
                  71,730
                  69,818
                  75,309
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1200
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  3,216
                  2,960
                  3,000
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1220
                  Other Proprietary Interest from the Public, FSMI Fund
                  4
                  3
                  3
               
               
                  1221
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  3,224
                  3,633
                  4,270
               
               
                  1223
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  8,666
                  8,748
                  8,795
               
               
                  1225
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  246
                  259
                  265
               
               
                  1226
                  Medicare Refunds, SMI
                  5,248
                  4,400
                  4,500
               
               
                  1227
                  Premiums Collected for the Aged, FSMI Fund
                  51,679
                  55,123
                  57,302
               
               
                  1229
                  Premiums Collected for the Disabled, FSMI Fund
                  10,091
                  10,094
                  10,285
               
               
                  
                  Offsetting receipts (intragovernmental):
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  176,940
                  192,491
                  194,343
               
               
                  1242
                  Federal Contributions, FSMI Fund
                  
                  
                  â60
               
               
                  1243
                  Interest Received by Trust Fund, FSMI Fund
                  2,511
                  2,786
                  3,274
               
               
                  1245
                  Interest Received by Trust Fund, FSMI Fund
                  
                  â34
                  â319
               
               
                  1246
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  
                  6
               
               
                  1247
                  Interest, Medicare Prescription Drug Account, FSMI
                  7
                  8
                  10
               
               
                  1248
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  367
                  373
                  418
               
               
                  1249
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  49,900
                  54,599
                  63,342
               
               
                  1251
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  Offsetting collections:
               
               
                  1280
                  Federal Supplementary Medical Insurance Trust Fund
                  11
                  
                  
               
               
                  1281
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  3,160
                  
                  
               
               
                  1299
                  Income under present law
                  315,271
                  335,444
                  349,435
               
               
                  
                  Proposed legislation:
               
               
                  
                  Offsetting receipts (proprietary receipts):
               
               
                  2222
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  â110
               
               
                  2224
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â80
               
               
                  2228
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â203
               
               
                  2230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â37
               
               
                  
                  Offsetting receipts (intragovernmental):
               
               
                  2241
                  Federal Contributions, FSMI Fund
                  
                  
                  â700
               
               
                  2244
                  Interest Received by Trust Fund, FSMI Fund
                  
                  â2
                  
               
               
                  2250
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â481
               
               
                  2299
                  Income under proposed legislation
                  
                  â2
                  â1,611
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total cash income
                  315,271
                  335,442
                  347,824
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  4500
                  Federal Supplementary Medical Insurance Trust Fund
                  â252,049
                  â255,810
                  â258,223
               
               
                  4500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â6,180
                  â13,657
               
               
                  4500
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â65,133
                  â67,596
                  â76,748
               
               
                  4599
                  Outgo under current law (-)
                  â317,182
                  â329,586
                  â348,628
               
               
                  
                  Proposed legislation:
               
               
                  5500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  925
               
               
                  5500
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â365
                  â760
               
               
                  5500
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  671
               
               
                  5599
                  Outgo under proposed legislation (-)
                  
                  â365
                  836
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  6599
                  Total cash outgo (-)
                  â317,182
                  â329,951
                  â347,792
               
               
                  
                  Manual Adjustments:
               
               
                  7690
                  Cash reconciliation adjustment
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  7699
                  Total adjustments
                  â1
                  
                  
               
               
                  
                  Unexpended balance, end of year:
               
               
                  8700
                  Uninvested balance (net), end of year
                  2,433
                  2,670
                  2,603
               
               
                  8701
                  Federal Supplementary Medical Insurance Trust Fund
                  67,385
                  72,639
                  72,738
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  8799
                  Total balance, end of year
                  69,818
                  75,309
                  75,341
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activity
                  14
                  330
                  145
               
               
                  42.0
                  Insurance claims and indemnities
                  249,529
                  252,533
                  254,968
               
               
                  94.0
                  Financial transfers
                  2,880
                  3,090
                  3,229
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  252,423
                  255,953
                  258,342
               
               
                  42.0
                  Allocation Account - reimbursable: Insurance claims and indemnities
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  252,434
                  255,953
                  258,342
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefits
                  
                  6,180
                  13,657
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  6,180
                  13,657
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  â34
                  â379
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  6,214
                  14,036
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  6,180
                  13,657
               
               
                  1900
                  Budget authority (total)
                  
                  6,180
                  13,657
               
               
                  1930
                  Total budgetary resources available
                  
                  6,180
                  13,657
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  6,180
                  13,657
               
               
                  3020
                  Outlays (gross)
                  
                  â6,180
                  â13,657
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  6,180
                  13,657
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  6,180
                  13,657
               
               
                  4180
                  Budget authority, net (total)
                  
                  6,180
                  13,657
               
               
                  4190
                  Outlays, net (total)
                  
                  6,180
                  13,657
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â2â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  
                  365
                  760
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  365
                  760
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â1,181
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  365
                  1,941
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  365
                  760
               
               
                  1900
                  Budget authority (total)
                  
                  365
                  760
               
               
                  1930
                  Total budgetary resources available
                  
                  365
                  760
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  365
                  760
               
               
                  3020
                  Outlays (gross)
                  
                  â365
                  â760
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  365
                  760
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  365
                  760
               
               
                  4180
                  Budget authority, net (total)
                  
                  365
                  760
               
               
                  4190
                  Outlays, net (total)
                  
                  365
                  760
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â940
               
               
                  0004
                  Administration, SMI
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  â925
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â1,101
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  176
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â925
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â925
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â925
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â925
               
               
                  3020
                  Outlays (gross)
                  
                  
                  925
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â925
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â925
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â925
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â925
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8004â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  
                  â940
               
               
                  94.0
                  Financial transfers
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  â925
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â0â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  69,358
                  67,239
                  76,396
               
               
                  0002
                  Administrative Costs
                  312
                  339
                  354
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  69,670
                  67,578
                  76,750
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2,555
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,555
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  348
                  334
                  344
               
               
                  1132
                  Appropriations temporarily reduced
                  â20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  328
                  334
                  344
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  63,698
                  67,244
                  76,406
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  63,698
                  67,244
                  76,406
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  3,160
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  3,160
                  
                  
               
               
                  1900
                  Budget authority (total)
                  67,186
                  67,578
                  76,750
               
               
                  1930
                  Total budgetary resources available
                  69,741
                  67,579
                  76,750
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â70
                  â1
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1951
                  Unobligated balance expiring
                  70
                  1
                  
               
               
                  1952
                  Expired unobligated balance, start of year
                  599
                  439
                  450
               
               
                  1953
                  Expired unobligated balance, end of year
                  369
                  449
                  449
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,607
                  7,397
                  7,379
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  69,670
                  67,578
                  76,750
               
               
                  3011
                  Obligations incurred, expired accounts
                  77
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â65,133
                  â67,596
                  â76,748
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2,555
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â269
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,397
                  7,379
                  7,381
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,607
                  7,397
                  7,379
               
               
                  3200
                  Obligated balance, end of year
                  7,397
                  7,379
                  7,381
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  328
                  334
                  344
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  210
                  232
                  241
               
               
                  4011
                  Outlays from discretionary balances
                  155
                  88
                  98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  365
                  320
                  339
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  66,858
                  67,244
                  76,406
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  59,477
                  60,503
                  72,005
               
               
                  4101
                  Outlays from mandatory balances
                  5,291
                  6,773
                  4,404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  64,768
                  67,276
                  76,409
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â3,160
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  64,026
                  67,578
                  76,750
               
               
                  4190
                  Outlays, net (total)
                  61,973
                  67,596
                  76,748
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  64,026
                  67,578
                  76,750
               
               
                  
                  Outlays
                  61,973
                  67,596
                  76,748
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â671
               
               
                  
                  Outlays
                  
                  
                  â671
               
               
                  Total:
               
               
                  
                  Budget Authority
                  64,026
                  67,578
                  76,079
               
               
                  
                  Outlays
                  61,973
                  67,596
                  76,077
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  312
                  339
                  354
               
               
                  42.0
                  Insurance claims and indemnities
                  69,358
                  67,239
                  76,396
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  69,670
                  67,578
                  76,750
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â8308â4â7â571
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  
                  
                  â671
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  
                  â671
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â671
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â671
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â671
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â671
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â671
               
               
                  3020
                  Outlays (gross)
                  
                  
                  671
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â671
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â671
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â671
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â671
               
               
                  
                     
                  
               
            
         
      
         Allocations Received from Other Accounts                                                                                 
            
         
         Note.âObligations incurred under allocations from other accounts are included in the schedule of the parent appropriation
            as in the following example: 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  16,488
                  16,486
                  16,486
               
               
                  0002
                  Territories - family assistance grants
                  78
                  78
                  78
               
               
                  0006
                  Tribal work programs
                  8
                  8
                  8
               
               
                  0009
                  Healthy marriage and responsible fatherhood grants
                  148
                  148
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  16,722
                  16,720
                  16,722
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  3
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  16,739
                  16,737
                  16,739
               
               
                  1220
                  Appropriations transferred to other accts [75â1552]
                  â36
                  
                  
               
               
                  1221
                  Appropriations transferred from other accts [75â1552]
                  36
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,738
                  16,737
                  16,739
               
               
                  1930
                  Total budgetary resources available
                  16,738
                  16,738
                  16,742
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â15
                  â15
                  â15
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  3
                  5
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,180
                  4,795
                  4,690
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  16,722
                  16,720
                  16,722
               
               
                  3020
                  Outlays (gross)
                  â17,107
                  â16,825
                  â16,805
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,795
                  4,690
                  4,607
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,180
                  4,795
                  4,690
               
               
                  3200
                  Obligated balance, end of year
                  4,795
                  4,690
                  4,607
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16,738
                  16,737
                  16,739
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  13,557
                  13,376
                  13,378
               
               
                  4101
                  Outlays from mandatory balances
                  3,550
                  3,449
                  3,427
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  17,107
                  16,825
                  16,805
               
               
                  4180
                  Budget authority, net (total)
                  16,738
                  16,737
                  16,739
               
               
                  4190
                  Outlays, net (total)
                  17,107
                  16,825
                  16,805
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  16,738
                  16,737
                  16,739
               
               
                  
                  Outlays
                  17,107
                  16,825
                  16,805
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  10
               
               
                  
                  Outlays
                  
                  
                  8
               
               
                  Total:
               
               
                  
                  Budget Authority
                  16,738
                  16,737
                  16,749
               
               
                  
                  Outlays
                  17,107
                  16,825
                  16,813
               
               
                  
                     
                  
               
            
         
      
      
         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, most recently
            in the Consolidated Appropriations Act, 2014 (P.L. 113â76).  
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  20
                  20
                  22
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16,698
                  16,696
                  16,696
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  16,722
                  16,720
                  16,722
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1552â0â1â609
                  2013 actual
                  2014 est.
                  2015 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Monitoring and Oversight
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.1)
                  
                  
                  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8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  8
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  10
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  8
               
               
                  
                     
                  
               
            
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  610
                  608
                  612
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  6
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  
                  2
                  6
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  612
                  612
                  612
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  612
                  612
                  612
               
               
                  1930
                  Total budgetary resources available
                  612
                  614
                  618
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  6
                  6
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  596
                  274
                  129
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  610
                  608
                  612
               
               
                  3020
                  Outlays (gross)
                  â699
                  â753
                  â683
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â233
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  274
                  129
                  58
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  596
                  274
                  129
               
               
                  3200
                  Obligated balance, end of year
                  274
                  129
                  58
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  612
                  612
                  612
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  487
                  553
                  555
               
               
                  4101
                  Outlays from mandatory balances
                  212
                  200
                  128
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  699
                  753
                  683
               
               
                  4180
                  Budget authority, net (total)
                  612
                  612
                  612
               
               
                  4190
                  Outlays, net (total)
                  699
                  753
                  683
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  612
                  612
                  612
               
               
                  
                  Outlays
                  699
                  753
                  683
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â10
               
               
                  
                  Outlays
                  
                  
                  â8
               
               
                  Total:
               
               
                  
                  Budget Authority
                  612
                  612
                  602
               
               
                  
                  Outlays
                  699
                  753
                  675
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  610
                  604
                  612
               
               
                  94.0
                  Financial transfers
                  
                  4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  610
                  608
                  612
               
               
                  
                     
                  
               
            
         
      
         Contingency Fund                                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1522â4â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  
                  
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â10
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â10
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â10
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â10
               
               
                  3020
                  Outlays (gross)
                  
                  
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â8
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â10
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â8
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support ProgramsFor carrying out, except as otherwise provided, [under] titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act of July 5, 1960[, $2,965,245,000] (24 U.S.C. 321â329), $2,438,523,000, to remain available until expended; and for such purposes for the first quarter of fiscal year [2015, $1,250,000,000] 2016, $1,160,000,000, to remain available until expended.
      
      For [making] carrying out, after May 31 of the current fiscal year, [payments to States or other non-Federal entities under] 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 (24 U.S.C. 321â329), for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums
         as may be necessary. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1501â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  3,716
                  3,633
                  3,386
               
               
                  0002
                  Child support incentive payments
                  510
                  520
                  527
               
               
                  0003
                  Access and visitation grants
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  4,236
                  4,163
                  3,923
               
               
                  0102
                  Payments to territories
                  33
                  33
                  33
               
               
                  0103
                  Repatriation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  34
                  34
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,270
                  4,197
                  3,957
               
               
                  0801
                  Offset obligations (CSE grants to States)
                  8
                  22
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  4,278
                  4,219
                  3,963
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  
                  68
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  269
                  200
                  200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  272
                  200
                  268
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,901
                  2,965
                  2,439
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  2,901
                  2,965
                  2,439
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  1,100
                  1,100
                  1,250
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1280
                  Advanced appropriation, mandatory (total)
                  1,100
                  1,100
                  1,250
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  7
                  22
                  6
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  5
                  22
                  6
               
               
                  1900
                  Budget authority (total)
                  4,006
                  4,087
                  3,695
               
               
                  1930
                  Total budgetary resources available
                  4,278
                  4,287
                  3,963
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  68
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  986
                  922
                  1,032
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4,278
                  4,219
                  3,963
               
               
                  3020
                  Outlays (gross)
                  â4,073
                  â3,909
                  â4,088
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â269
                  â200
                  â200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  922
                  1,032
                  707
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  2
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  984
                  922
                  1,032
               
               
                  3200
                  Obligated balance, end of year
                  922
                  1,032
                  707
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,006
                  4,087
                  3,695
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,497
                  3,669
                  3,552
               
               
                  4101
                  Outlays from mandatory balances
                  576
                  240
                  536
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,073
                  3,909
                  4,088
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â7
                  â22
                  â6
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  4,001
                  4,065
                  3,689
               
               
                  4170
                  Outlays, net (mandatory)
                  4,066
                  3,887
                  4,082
               
               
                  4180
                  Budget authority, net (total)
                  4,001
                  4,065
                  3,689
               
               
                  4190
                  Outlays, net (total)
                  4,066
                  3,887
                  4,082
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,001
                  4,065
                  3,689
               
               
                  
                  Outlays
                  4,066
                  3,887
                  4,082
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  10
               
               
                  
                  Outlays
                  
                  
                  10
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,001
                  4,065
                  3,699
               
               
                  
                  Outlays
                  4,066
                  3,887
                  4,092
               
               
                  
                     
                  
               
            
         
      
      
         This account provides for payments to States for child support enforcement and other family support programs, including access
            and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
            account.  The Budget 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  4,270
                  4,197
                  3,957
               
               
                  99.0
                  Reimbursable obligations
                  8
                  22
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  4,278
                  4,219
                  3,963
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 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), [and] (d), and (e) of section 2602 of the Low Income Home Energy Assistance Act of 1981, [$3,424,549,000] $2,750,000,000, of which $2,550,000,000 shall be for making payments under subsections (b) and (d) of such section; and of
            which $200,000,000 shall be for making payments under subsection (e) of such section, to be made notwithstanding the designation
            requirements of such subsection: Provided, That all but [$491,000,000] $366,000,000 of [this] 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 [2014] 2015 was less than $1,975,000,000: Provided further, That, notwithstanding section 2609A(a), of the amounts appropriated under section 2602(b), not more than [$2,988,000] $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 current grantees to assist low-income households in reducing home energy burden and for
            conducting a national evaluation of such grants, $50,000,000.  (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1502â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  LIHEAP Block Grant
                  3,255
                  3,425
                  2,550
               
               
                  0002
                  Contingency Fund
                  
                  
                  200
               
               
                  0003
                  Energy Burden Reduction Grants
                  
                  
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  3,255
                  3,425
                  2,800
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,472
                  3,425
                  2,800
               
               
                  1120
                  Appropriations transferred to other accts [75â1503]
                  â29
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0350]
                  â6
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â182
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,255
                  3,425
                  2,800
               
               
                  1930
                  Total budgetary resources available
                  3,255
                  3,425
                  2,800
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,642
                  1,361
                  1,703
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  3,255
                  3,425
                  2,800
               
               
                  3020
                  Outlays (gross)
                  â3,532
                  â3,083
                  â2,892
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,361
                  1,703
                  1,611
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,642
                  1,361
                  1,703
               
               
                  3200
                  Obligated balance, end of year
                  1,361
                  1,703
                  1,611
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,255
                  3,425
                  2,800
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,180
                  2,158
                  1,767
               
               
                  4011
                  Outlays from discretionary balances
                  1,352
                  925
                  1,125
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,532
                  3,083
                  2,892
               
               
                  4180
                  Budget authority, net (total)
                  3,255
                  3,425
                  2,800
               
               
                  4190
                  Outlays, net (total)
                  3,532
                  3,083
                  2,892
               
               
                  
                     
                  
               
            
         
      
      
         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.  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
                  2013 actual
                  2014 est.
                  2015 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
                  3,252
                  3,422
                  2,797
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  3,255
                  3,425
                  2,800
               
               
                  
                     
                  
               
            
         
      
         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, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the Trafficking
         Victims Protection Act of 2000 ("TVPA''), section 203 of the Trafficking Victims Protection Reauthorization Act of 2005, and
         the Torture Victims Relief Act of 1998, [$1,486,095,000] $1,486,129,000, of which [$1,461,605,000] $1,453,394,000 shall remain available through September 30, [2016] 2017, for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out such section 203 and the TVPA shall also be available for research
         and evaluation with respect to activities under those authorities: Provided further, That a contingency fund, to be available until expended, shall be established for the unaccompanied alien
            children program authorized by section 462 of the Homeland Security Act of 2002 and section 235 of the William Wilberforce
            Trafficking Victims Protection Reauthorization Act of 2008: Provided further, That all available balances from this appropriation
            available for such activities may be deposited in such fund prior to expiration. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Refugee and entrant assistance
                  603
                  593
                  585
               
               
                  0002
                  Assistance for treatment of torture victims
                  11
                  11
                  11
               
               
                  0003
                  Unaccompanied alien children
                  376
                  868
                  868
               
               
                  0005
                  Trafficking Victims program
                  9
                  14
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  999
                  1,486
                  1,486
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  2
                  2
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2
                  2
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,016
                  1,486
                  1,486
               
               
                  1120
                  Appropriations transferred to other accts [75â1503]
                  â1,003
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1503]
                  1,003
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1515]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1502]
                  29
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â47
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  999
                  1,486
                  1,486
               
               
                  1930
                  Total budgetary resources available
                  1,001
                  1,488
                  1,488
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  544
                  537
                  902
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  999
                  1,486
                  1,486
               
               
                  3020
                  Outlays (gross)
                  â997
                  â1,121
                  â1,398
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  537
                  902
                  990
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  544
                  537
                  902
               
               
                  3200
                  Obligated balance, end of year
                  537
                  902
                  990
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  999
                  1,486
                  1,486
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  612
                  743
                  743
               
               
                  4011
                  Outlays from discretionary balances
                  385
                  378
                  655
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  997
                  1,121
                  1,398
               
               
                  4180
                  Budget authority, net (total)
                  999
                  1,486
                  1,486
               
               
                  4190
                  Outlays, net (total)
                  997
                  1,121
                  1,398
               
               
                  
                     
                  
               
            
         
      
      
         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 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  4
                  6
                  6
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  2
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  35
                  62
                  63
               
               
                  25.2
                  Other services from non-Federal sources
                  11
                  7
                  7
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  49
                  49
               
               
                  41.0
                  Grants, subsidies, and contributions
                  939
                  1,357
                  1,356
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  999
                  1,486
                  1,486
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1503â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  53
                  73
                  81
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable FamiliesFor 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, $59,765,000. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  349
                  343
                  365
               
               
                  0002
                  Research, training and technical assistance
                  8
                  8
                  8
               
               
                  0003
                  State court improvement activities
                  30
                  30
                  32
               
               
                  0004
                  Family Connection Grants
                  14
                  
                  
               
               
                  0005
                  PREP
                  79
                  78
                  
               
               
                  0006
                  Abstinence Education
                  37
                  35
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  517
                  494
                  405
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  16
                  9
                  11
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  17
                  9
                  11
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  63
                  60
                  60
               
               
                  1130
                  Appropriations permanently reduced
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  60
                  60
                  60
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  485
                  470
                  345
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â25
                  â34
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  460
                  436
                  345
               
               
                  1900
                  Budget authority (total)
                  520
                  496
                  405
               
               
                  1930
                  Total budgetary resources available
                  537
                  505
                  416
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â11
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  9
                  11
                  11
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  677
                  622
                  562
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  517
                  494
                  405
               
               
                  3020
                  Outlays (gross)
                  â565
                  â554
                  â497
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  622
                  562
                  470
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  677
                  622
                  562
               
               
                  3200
                  Obligated balance, end of year
                  622
                  562
                  470
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  60
                  60
                  60
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  20
                  19
                  19
               
               
                  4011
                  Outlays from discretionary balances
                  48
                  44
                  40
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  68
                  63
                  59
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  460
                  436
                  345
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  97
                  91
                  95
               
               
                  4101
                  Outlays from mandatory balances
                  400
                  400
                  343
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  497
                  491
                  438
               
               
                  4180
                  Budget authority, net (total)
                  520
                  496
                  405
               
               
                  4190
                  Outlays, net (total)
                  565
                  554
                  497
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  520
                  496
                  405
               
               
                  
                  Outlays
                  565
                  554
                  497
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  90
               
               
                  
                  Outlays
                  
                  
                  2
               
               
                  Total:
               
               
                  
                  Budget Authority
                  520
                  496
                  495
               
               
                  
                  Outlays
                  565
                  554
                  499
               
               
                  
                     
                  
               
            
         
      
      
         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) which was made
            available by the Patient Protection and Affordable Care Act (P.L. 111â148). The Budget includes a five-year reauthorization
            of PREP as well as continuation of Family Connection Grants through 2016.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  9
                  11
                  11
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  503
                  480
                  392
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  517
                  494
                  405
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  10
                  10
                  2
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable Families                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0004
                  Family Connection Grants
                  
                  
                  15
               
               
                  0005
                  PREP
                  
                  
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  90
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  90
               
               
                  1900
                  Budget authority (total)
                  
                  
                  90
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  90
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  90
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  88
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  88
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  90
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  90
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  2
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  6
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  90
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1512â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  8
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Mandatory child care
                  1,178
                  1,178
                  1,178
               
               
                  0002
                  Matching child care
                  1,691
                  1,674
                  1,674
               
               
                  0003
                  Training and technical assistance
                  7
                  7
                  7
               
               
                  0004
                  Child care tribal grants
                  58
                  58
                  58
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,934
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  17
                  
                  
               
               
                  
                  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
                  2,934
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  711
                  755
                  771
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,934
                  2,917
                  2,917
               
               
                  3020
                  Outlays (gross)
                  â2,872
                  â2,901
                  â2,912
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  755
                  771
                  776
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  711
                  755
                  771
               
               
                  3200
                  Obligated balance, end of year
                  755
                  771
                  776
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,264
                  2,363
                  2,363
               
               
                  4101
                  Outlays from mandatory balances
                  608
                  538
                  549
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,872
                  2,901
                  2,912
               
               
                  4180
                  Budget authority, net (total)
                  2,917
                  2,917
                  2,917
               
               
                  4190
                  Outlays, net (total)
                  2,872
                  2,901
                  2,912
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays
                  2,872
                  2,901
                  2,912
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  750
               
               
                  
                  Outlays
                  
                  
                  600
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  3,667
               
               
                  
                  Outlays
                  2,872
                  2,901
                  3,512
               
               
                  
                     
                  
               
            
         
      
      
         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, most recently in the Consolidated Appropriations
            Act, 2014 (P.L. 113â76).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  6
                  6
                  6
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,927
                  2,910
                  2,910
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,934
                  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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Matching child care
                  
                  
                  706
               
               
                  0003
                  Training and technical assistance
                  
                  
                  11
               
               
                  0004
                  Child care tribal grants
                  
                  
                  33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  750
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  750
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  750
               
               
                  1900
                  Budget authority (total)
                  
                  
                  750
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  750
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  750
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â600
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  150
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  150
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  750
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  600
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  750
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  600
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1550â4â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  11
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  739
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  750
               
               
                  
                     
                  
               
            
         
      
         Payments to States for the Child Care and Development Block GrantFor carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act''), [$2,360,000,000] $2,417,000,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families:
         Provided, That [$19,357,000] $19,824,500 shall be available for child care resource and referral and school-aged child care activities, of which [$996,000] $1,000,000 shall be available to the Secretary for a competitive grant for the operation of a national toll free referral line 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 of the CCDBG Act, [$296,484,000] $303,645,000 shall be reserved by the States for activities authorized under section 658G, of which [$108,732,000] $111,358,000 shall be for activities that improve the quality of infant and toddler care: Provided further, That [$9,851,000] $9,871,000 shall be for use by the Secretary for child care research, demonstration, and evaluation activities: Provided further, That technical assistance under section 658I(a)(3) of such Act may be provided directly, or through the use of contracts,
         grants, cooperative agreements, or interagency agreements:Provided further, That $200,000,000 shall be made available, using the allocation formula in section 658O of the CCDBG Act,
            for grants to each State, territory, and Indian tribe and tribal organization that submits a plan to be approved by the Secretary
            demonstrating how it will use these funds to improve the quality of child care, including the quality of the child care workforce,
            and health and safety measures. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Block grant payments to States
                  2,197
                  2,350
                  2,407
               
               
                  0004
                  Research and evaluation fund
                  9
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,206
                  2,360
                  2,417
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,328
                  2,360
                  2,417
               
               
                  1120
                  Appropriations transferred to other accts [75â1515]
                  â12
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â1503]
                  â1
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â1362]
                  â2
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â1515]
                  12
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â119
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,206
                  2,360
                  2,417
               
               
                  1930
                  Total budgetary resources available
                  2,206
                  2,360
                  2,417
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  555
                  583
                  605
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,206
                  2,360
                  2,417
               
               
                  3020
                  Outlays (gross)
                  â2,177
                  â2,338
                  â2,413
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  583
                  605
                  609
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  555
                  583
                  605
               
               
                  3200
                  Obligated balance, end of year
                  583
                  605
                  609
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,206
                  2,360
                  2,417
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,706
                  1,912
                  1,958
               
               
                  4011
                  Outlays from discretionary balances
                  471
                  426
                  455
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,177
                  2,338
                  2,413
               
               
                  4180
                  Budget authority, net (total)
                  2,206
                  2,360
                  2,417
               
               
                  4190
                  Outlays, net (total)
                  2,177
                  2,338
                  2,413
               
               
                  
                     
                  
               
            
         
      
      
         This program provides grants to States for child care subsidies for low-income working families and activities to improve
            child care quality. In FY 2015, it includes a new initiative to improve the quality of child care, including health and safety
            measures.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  25.1
                  Advisory and assistance services
                  11
                  11
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,194
                  2,348
                  2,399
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,206
                  2,360
                  2,417
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1515â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  13
               
               
                  
                     
                  
               
            
         
      
         Social Services Block GrantFor making grants to States pursuant to section 2002 of the Social Security Act, $1,700,000,000: Provided, That notwithstanding subparagraph (B) of section 404(d)(2) of such Act, the applicable percent specified under such subparagraph
         for a State to carry out State programs pursuant to title XX-A of such Act shall be 10 percent. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  1,613
                  1,577
                  1,700
               
               
                  0002
                  Health Profession Opportunity Grants
                  81
                  79
                  
               
               
                  0003
                  Hurricane Sandy Funding
                  474
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,168
                  1,656
                  1,700
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  29
                  30
                  30
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  30
                  30
                  30
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,785
                  1,785
                  1,700
               
               
                  1221
                  Appropriations transferred from other accts [75â0140]
                  500
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â117
                  â129
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  2,168
                  1,656
                  1,700
               
               
                  1900
                  Budget authority (total)
                  2,168
                  1,656
                  1,700
               
               
                  1930
                  Total budgetary resources available
                  2,198
                  1,686
                  1,730
               
               
                  
                  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
                  572
                  862
                  653
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,168
                  1,656
                  1,700
               
               
                  3020
                  Outlays (gross)
                  â1,877
                  â1,865
                  â1,996
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  862
                  653
                  357
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  572
                  862
                  653
               
               
                  3200
                  Obligated balance, end of year
                  862
                  653
                  357
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,168
                  1,656
                  1,700
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,395
                  1,328
                  1,428
               
               
                  4101
                  Outlays from mandatory balances
                  482
                  537
                  568
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,877
                  1,865
                  1,996
               
               
                  4180
                  Budget authority, net (total)
                  2,168
                  1,656
                  1,700
               
               
                  4190
                  Outlays, net (total)
                  1,877
                  1,865
                  1,996
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,168
                  1,656
                  1,700
               
               
                  
                  Outlays
                  1,877
                  1,865
                  1,996
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  85
               
               
                  
                  Outlays
                  
                  
                  2
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,168
                  1,656
                  1,785
               
               
                  
                  Outlays
                  1,877
                  1,865
                  1,998
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  9
                  16
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,156
                  1,639
                  1,700
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,168
                  1,656
                  1,700
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  10
                  10
                  
               
               
                  
                     
                  
               
            
         
      
         Social Services Block Grant                                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Health Profession Opportunity Grants
                  
                  
                  85
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  85
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  85
               
               
                  1900
                  Budget authority (total)
                  
                  
                  85
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  85
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  85
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  83
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  83
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  85
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  85
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  2
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  3
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  10
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  71
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  85
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1534â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  10
               
               
                  
                     
                  
               
            
         
      
         Children and Families Services ProgramsFor carrying out, except as otherwise provided, the Runaway and Homeless Youth 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, 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; 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, [$10,346,943,000] $10,277,062,000, of which $37,943,000, to remain available through September 30, [2015] 2016, 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, [2014] 2015: Provided, That subsection (b)(5) of such section 473A shall apply to funds appropriated under this heading by substituting ["2013''] "2014" for "2012'': Provided further, That [$8,598,095,000] $8,868,389,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, [$8,073,095,000] $8,193,389,000 shall be available for payments under section 640 of the Head Start Act[, of which $100,000,000 shall be available for a cost of living adjustment notwithstanding section 640(a)(3)(A) of such Act:
         Provided further, That for purposes of allocating funds under section 640 of the Head Start Act, subsection (a)(2) of such section shall be
         applied by substituting "fiscal year 2012'' for "the prior fiscal year'' each place it appears in such subsection]: Provided further, That of the amount provided for making payments under the Head Start Act, $25,000,000 shall be available 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: 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 provided for making payments under the Head Start
         Act, [$500,000,000] $650,000,000 shall be available through March 31, [2015] 2016 for [expansion of] Early Head Start programs as described in section 645A 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, to entities
         defined as eligible under section 645A(d) of such Act, 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 [$10,000,000] $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] 2015, 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 amounts provided under the seventh proviso under this heading in Public Law 113â76 shall not be included
            in the calculation of the "base grant'' in fiscal year 2015, as such term is used in section 640(a)(7)(A) of the Head Start
            Act: Provided further, That [$709,854,000] $350,000,000 shall be for making payments under the CSBG Act: Provided further, That [$36,204,000 shall be for sections 680 and 678E(b)(2) of the CSBG Act, of which not less than $29,883,000 shall be for section
         680(a)(2) and not less than $5,971,000 shall be for section 680(a)(3)(B) 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 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:], 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, during the fiscal
            year of such recapture, reallocated among other qualified entities, to remain available to such entities for five years: Provided
            further, That notwithstanding section 414(e) of such Act, the Secretary may award up to $1,000,000 to support evidence-based
            evaluation: 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 previous proviso, shall remain available until expended: 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 $1,864,000 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 up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States
         to support data collection for a study of the system's effectiveness. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Head Start
                  7,573
                  8,598
                  8,868
               
               
                  0102
                  Head Start Emergency Hurricane Sandy funding
                  8
                  
                  
               
               
                  0103
                  Runaway and homeless youth (basic centers)
                  50
                  53
                  53
               
               
                  0104
                  Transitional living
                  41
                  44
                  44
               
               
                  0105
                  Prevalence, Needs and Characteristics of Homeless Youth
                  
                  
                  2
               
               
                  0106
                  Education grants to reduce sexual abuse of runaway youth
                  17
                  17
                  17
               
               
                  0109
                  Child abuse State grants
                  25
                  25
                  25
               
               
                  0110
                  Child abuse discretionary activities
                  24
                  29
                  29
               
               
                  0111
                  Community-based child abuse prevention
                  39
                  40
                  40
               
               
                  0112
                  Child welfare services
                  263
                  269
                  269
               
               
                  0113
                  Child welfare training, research, or demonstration projects
                  24
                  25
                  25
               
               
                  0114
                  Adoption opportunities
                  36
                  40
                  40
               
               
                  0115
                  Abandoned infants assistance
                  11
                  11
                  11
               
               
                  0116
                  Adoption incentives
                  37
                  38
                  38
               
               
                  0117
                  Independent living training vouchers
                  42
                  43
                  43
               
               
                  0119
                  State councils on developmental disabilities
                  70
                  
                  
               
               
                  0120
                  Protection and advocacy
                  39
                  
                  
               
               
                  0121
                  Projects of national significance
                  8
                  
                  
               
               
                  0122
                  University centers for excellence
                  37
                  
                  
               
               
                  0123
                  Voting access for individuals with disabilities
                  5
                  
                  
               
               
                  0124
                  Native American programs
                  45
                  47
                  47
               
               
                  0125
                  Social services and income maintenance research
                  
                  
                  9
               
               
                  0128
                  Federal administration
                  201
                  198
                  205
               
               
                  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
                  8,598
                  9,480
                  9,768
               
               
                  0301
                  Community services block grant
                  635
                  674
                  350
               
               
                  0303
                  Rural community facilities
                  5
                  6
                  
               
               
                  0304
                  Community services discretionary (JOLI & CED)
                  28
                  30
                  
               
               
                  0306
                  Assets for independence
                  19
                  19
                  19
               
               
                  0308
                  Domestic violence hotline
                  3
                  4
                  5
               
               
                  0309
                  Family violence prevention and services
                  121
                  134
                  135
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0391
                  Direct program activities, subtotal
                  811
                  867
                  509
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total, direct program
                  9,409
                  10,347
                  10,277
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  9,409
                  10,347
                  10,277
               
               
                  0801
                  Reimbursable program
                  35
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  35
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  9,444
                  10,377
                  10,307
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  89
                  84
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  2
                  89
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  9,941
                  10,347
                  10,277
               
               
                  1120
                  Appropriations transferred to other accts [75â1362]
                  â21
                  
                  
               
               
                  1121
                  Appropriations transferred from other accounts [75â0140]
                  100
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â523
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  9,497
                  10,347
                  10,277
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  21
                  24
                  24
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  33
                  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)
                  9,532
                  10,372
                  10,302
               
               
                  1930
                  Total budgetary resources available
                  9,534
                  10,461
                  10,386
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  89
                  84
                  79
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,628
                  6,218
                  6,676
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  9,444
                  10,377
                  10,307
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â9,751
                  â9,919
                  â10,217
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â105
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,218
                  6,676
                  6,766
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â10
                  â16
                  â16
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â16
                  â16
                  â16
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,618
                  6,202
                  6,660
               
               
                  3200
                  Obligated balance, end of year
                  6,202
                  6,660
                  6,750
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  9,530
                  10,371
                  10,301
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  3,942
                  4,371
                  4,343
               
               
                  4011
                  Outlays from discretionary balances
                  5,808
                  5,546
                  5,874
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  9,750
                  9,917
                  10,217
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â27
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â27
                  â24
                  â24
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  9,497
                  10,347
                  10,277
               
               
                  4080
                  Outlays, net (discretionary)
                  9,723
                  9,893
                  10,193
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  1
                  1
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  1
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1
                  2
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â2
                  â1
                  â1
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â1
                  1
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  9,497
                  10,347
                  10,277
               
               
                  4190
                  Outlays, net (total)
                  9,722
                  9,894
                  10,192
               
               
                  
                     
                  
               
            
         
      
      
         The request prioritizes investments in early learning to improve outcomes for children. A total of $8.9 billion is requested
            to support an early learning initiative to expand access to high quality infant and toddler care, Head Start services, and
            support the transition between new and incumbent Head Start grantees in the Designation Renewal System. This Budget also requests
            an additional $1 million for family violence prevention, $9 million for research to improve effectiveness of programs serving
            children and adolescents, and $2 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  109
                  111
                  115
               
               
                  11.3
                  Other than full-time permanent
                  5
                  5
                  5
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  115
                  117
                  121
               
               
                  12.1
                  Civilian personnel benefits
                  31
                  32
                  33
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  15
                  14
                  14
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  4
                  4
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  190
                  202
                  208
               
               
                  25.2
                  Other services from non-Federal sources
                  3
                  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
                  8,997
                  9,915
                  9,834
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  9,409
                  10,347
                  10,277
               
               
                  99.0
                  Reimbursable obligations
                  35
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  9,444
                  10,377
                  10,307
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1536â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,126
                  1,139
                  1,174
               
               
                  1101
                  Direct military average strength employment
                  7
                  7
                  7
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  11
                  19
                  19
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Training and technical assistance
                  12
                  15
                  12
               
               
                  0002
                  Federal parent locator service
                  24
                  24
                  25
               
               
                  0004
                  Welfare research
                  14
                  14
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  50
                  53
                  52
               
               
                  0801
                  Reimbursable program FPLS REIMB
                  23
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  73
                  83
                  82
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  7
                  5
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  52
                  52
                  52
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  49
                  48
                  52
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  23
                  30
                  30
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  
                  1
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  22
                  30
                  30
               
               
                  1900
                  Budget authority (total)
                  71
                  78
                  82
               
               
                  1930
                  Total budgetary resources available
                  78
                  83
                  82
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  60
                  64
                  69
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  73
                  83
                  82
               
               
                  3020
                  Outlays (gross)
                  â69
                  â78
                  â81
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  64
                  69
                  70
               
               
                  
                  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
                  55
                  59
                  64
               
               
                  3200
                  Obligated balance, end of year
                  59
                  64
                  65
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  71
                  78
                  82
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  21
                  28
                  28
               
               
                  4101
                  Outlays from mandatory balances
                  48
                  50
                  53
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  69
                  78
                  81
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â11
                  â13
                  â13
               
               
                  4123
                  Non-Federal sources
                  â12
                  â17
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â23
                  â30
                  â30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  48
                  48
                  52
               
               
                  4170
                  Outlays, net (mandatory)
                  46
                  48
                  51
               
               
                  4180
                  Budget authority, net (total)
                  48
                  48
                  52
               
               
                  4190
                  Outlays, net (total)
                  46
                  48
                  51
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unavailable balance, SOY: Offsetting collections
                  
                  1
                  1
               
               
                  5091
                  Unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         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 September
            30, 2014, in the Consolidated Appropriations Act, 2014 (P.L. 113â76).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â609
                  2013 actual
                  2014 est.
                  2015 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
                  12
                  11
                  12
               
               
                  25.2
                  Other services from non-Federal sources
                  13
                  17
                  14
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  9
                  10
               
               
                  25.7
                  Operation and maintenance of equipment
                  2
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1
                  3
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  50
                  53
                  52
               
               
                  99.0
                  Reimbursable obligations
                  23
                  30
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  73
                  83
                  82
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1553â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  67
                  67
                  67
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and PermanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, [$4,806,000,000] $4,832,000,000.
      
      For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
         [2015, $2,200,000,000] 2016, $2,300,000,000.
      
      For [making] carrying out, after May 31 of the current fiscal year, [payments to States or other non-Federal entities under] except as otherwise provided, section 474 of title IV-E of the Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs,
         incurred for the current fiscal year, such sums as may be necessary. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  4,133
                  4,269
                  4,289
               
               
                  0002
                  Independent living
                  140
                  140
                  140
               
               
                  0004
                  Adoption assistance
                  2,278
                  2,384
                  2,504
               
               
                  0005
                  Guardianship
                  77
                  85
                  99
               
               
                  0006
                  Tribal T&TA
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  6,631
                  6,881
                  7,035
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  4,531
                  4,809
                  4,835
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  4,531
                  4,809
                  4,835
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  2,100
                  2,200
                  2,200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1280
                  Advanced appropriation, mandatory (total)
                  2,100
                  2,200
                  2,200
               
               
                  1900
                  Budget authority (total)
                  6,631
                  7,009
                  7,035
               
               
                  1930
                  Total budgetary resources available
                  6,631
                  7,009
                  7,035
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  
                  â128
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  979
                  716
                  782
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  6,631
                  6,881
                  7,035
               
               
                  3011
                  Obligations incurred, expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â6,770
                  â6,803
                  â6,952
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â128
                  â12
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  716
                  782
                  865
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  979
                  716
                  782
               
               
                  3200
                  Obligated balance, end of year
                  716
                  782
                  865
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  6,631
                  7,009
                  7,035
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6,066
                  6,246
                  6,387
               
               
                  4101
                  Outlays from mandatory balances
                  704
                  557
                  565
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6,770
                  6,803
                  6,952
               
               
                  4180
                  Budget authority, net (total)
                  6,631
                  7,009
                  7,035
               
               
                  4190
                  Outlays, net (total)
                  6,770
                  6,803
                  6,952
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  6,631
                  7,009
                  7,035
               
               
                  
                  Outlays
                  6,770
                  6,803
                  6,952
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  252
               
               
                  
                  Outlays
                  
                  
                  3
               
               
                  Total:
               
               
                  
                  Budget Authority
                  6,631
                  7,009
                  7,287
               
               
                  
                  Outlays
                  6,770
                  6,803
                  6,955
               
               
                  
                     
                  
               
            
         
      
      
         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 CareâThe proposed level will support eligible low-income children who must be placed outside the home. An average of 150,800 children
            per month are estimated to be served in FY 2015.
         
         Adoption AssistanceâThe proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
            An average of 452,000 children per month are estimated to be served in FY 2015.
         
         Guardianship AssistanceâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 21,100 children per month are estimated to be served in FY 2015.
         
         This account includes a new initiative to address over-prescription of psychotropic medications for children in foster care
            and a new requirement to use child support collected on behalf of children in foster care in the best interest of the child.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  16
                  21
                  21
               
               
                  41.0
                  Grants, subsidies, and contributions
                  6,615
                  6,860
                  7,014
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  6,631
                  6,881
                  7,035
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â0â1â609
                  2013 actual
                  2014 est.
                  2015 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  
                  
                  2
               
               
                  0007
                  Address over-prescription of psychotropic medications for children in foster care
                  
                  
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  52
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  252
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  252
               
               
                  1900
                  Budget authority (total)
                  
                  
                  252
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  252
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  200
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  52
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  49
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  49
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  252
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  252
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â4â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  23
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  52
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â1545â4â1â609
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  2
               
               
                  
                     
                  
               
            
         
      
         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"), 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, 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, [$1,610,143,000] $2,010,164,000, together with $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 Reconciliation Act of 1990: Provided, That, in addition to amounts provided herein, $12,860,000 shall be available from amounts available under section
            241 of the PHS Act to supplement funds otherwise available for carrying out titles III and XXIX of such Act: Provided further, 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, $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,
            2016, and may be recaptured and reobligated in accordance with section 517(c) of the OAA: Provided further, That $3,000,000
            shall be available until September 30, 2016, for the White House Conference on Aging.  (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Home and community-based supportive services
                  348
                  348
                  347
               
               
                  0102
                  Preventive health services
                  20
                  20
                  20
               
               
                  0103
                  National family caregiver support program
                  146
                  146
                  146
               
               
                  0104
                  Native American caregiver support program
                  6
                  6
                  6
               
               
                  0105
                  Congregate nutrition services
                  416
                  438
                  437
               
               
                  0106
                  Home-delivered nutrition services
                  205
                  216
                  216
               
               
                  0107
                  Nutrition services incentive program
                  144
                  158
                  160
               
               
                  0108
                  Native American nutrition and supportive services
                  26
                  26
                  26
               
               
                  0110
                  Aging network support activities
                  7
                  7
                  7
               
               
                  0111
                  Long-term care ombudsmen program
                  16
                  16
                  16
               
               
                  0112
                  Prevention of elder abuse and neglect
                  5
                  5
                  5
               
               
                  0113
                  Alzheimer's Disease Demo Grants ADSSP
                  4
                  4
                  
               
               
                  0114
                  Program administration
                  22
                  30
                  30
               
               
                  0115
                  Lifespan respite care program
                  2
                  2
                  
               
               
                  0116
                  Paralysis Resource Center
                  
                  7
                  
               
               
                  0117
                  Aging and Disability Resource Centers (ADRC)
                  6
                  6
                  
               
               
                  0118
                  Chronic Disease Self-Management Education Program PPHF
                  7
                  8
                  8
               
               
                  0121
                  Senior Medicare Patrol program
                  9
                  9
                  9
               
               
                  0122
                  Elder Rights Support Activities
                  4
                  4
                  4
               
               
                  0123
                  Falls Prevention - PPHF
                  
                  5
                  5
               
               
                  0124
                  Elder Justice Initiative
                  
                  
                  25
               
               
                  0126
                  National Clearinghouse Long-Term Care Information
                  
                  
                  1
               
               
                  0127
                  Alzheimer's Disease Communications Campaign PPHF
                  
                  4
                  4
               
               
                  0128
                  Adult Protective Services - ACA
                  2
                  
                  
               
               
                  0129
                  Senior Community Service Employment Program
                  
                  
                  380
               
               
                  0132
                  State Aging & Disability Resource Centers - HCR
                  9
                  10
                  
               
               
                  0133
                  Alzheimer's Disease Initiative - Services PPHF
                  
                  11
                  11
               
               
                  0136
                  Voting Access for People With Disabilities (HAVA)
                  
                  5
                  5
               
               
                  0138
                  State Councils on Developmental Disabilities
                  
                  71
                  71
               
               
                  0139
                  Protection and Advocacy
                  
                  39
                  39
               
               
                  0141
                  University Centers for Excellence in Developmental Disabilities
                  
                  37
                  37
               
               
                  0142
                  Projects of National Significance
                  
                  9
                  9
               
               
                  0145
                  Youth Transitions Initiative
                  
                  
                  5
               
               
                  0146
                  White House Conference on Aging
                  
                  
                  3
               
               
                  0147
                  Holocaust Survivor Assistance Fund
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  1,404
                  1,647
                  2,037
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  1,404
                  1,647
                  2,037
               
               
                  0801
                  Reimbursable program - HCFAC and Other
                  11
                  11
                  12
               
               
                  0802
                  ADRC's MIPPA (TRA)
                  5
                  2
                  
               
               
                  0803
                  Area Agencies on Aging - MIPPA (TRA)
                  7
                  4
                  
               
               
                  0804
                  MIPPA - Natl Center Benefits Outreach Enrollment
                  5
                  3
                  
               
               
                  0805
                  SHIP - (DISC and ATRA BBA)
                  
                  55
                  52
               
               
                  0806
                  Alzheimers Disease Supportive Services Program - PHS
                  
                  
                  4
               
               
                  0807
                  Paralysis Resource Center PHS
                  
                  
                  7
               
               
                  0808
                  Lifespan Respite - PHS
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  28
                  75
                  77
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,432
                  1,722
                  2,114
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,471
                  1,610
                  2,010
               
               
                  1120
                  Appropriations transferred to other accts [12â3507]
                  â3
                  â2
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0943]
                  â5
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0350]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â77
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,385
                  1,608
                  2,010
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  14
                  10
                  
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [75â0116]
                  9
                  28
                  28
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â4
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  19
                  37
                  28
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  52
                  65
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  
                  52
                  65
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1
                  24
                  11
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  27
                  24
                  11
               
               
                  1900
                  Budget authority (total)
                  1,431
                  1,721
                  2,114
               
               
                  1930
                  Total budgetary resources available
                  1,433
                  1,722
                  2,114
               
               
                  
                  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
                  691
                  667
                  750
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,432
                  1,722
                  2,114
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,448
                  â1,639
                  â1,959
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  667
                  750
                  905
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â18
                  â36
                  â36
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â26
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â36
                  â36
                  â36
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  673
                  631
                  714
               
               
                  3200
                  Obligated balance, end of year
                  631
                  714
                  869
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,385
                  1,660
                  2,075
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  885
                  1,033
                  1,291
               
               
                  4011
                  Outlays from discretionary balances
                  530
                  563
                  622
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,415
                  1,596
                  1,913
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  
                  â52
                  â65
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  46
                  61
                  39
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  42
                  28
               
               
                  4101
                  Outlays from mandatory balances
                  30
                  1
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  33
                  43
                  46
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â8
                  â24
                  â11
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â26
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  19
                  37
                  28
               
               
                  4170
                  Outlays, net (mandatory)
                  25
                  19
                  35
               
               
                  4180
                  Budget authority, net (total)
                  1,404
                  1,645
                  2,038
               
               
                  4190
                  Outlays, net (total)
                  1,440
                  1,563
                  1,883
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,404
                  1,645
                  2,038
               
               
                  
                  Outlays
                  1,440
                  1,563
                  1,883
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  20
               
               
                  
                  Outlays
                  
                  
                  20
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,404
                  1,645
                  2,058
               
               
                  
                  Outlays
                  1,440
                  1,563
                  1,903
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the Administration for Community Living (ACL) reflects the actual distribution of
            the allocation account for 2013. Future allocations will be determined annually. 
         
         This account provides funding for formula grant programs that provide nutrition, supportive services and caregiver support
            services, and protection and advocacy services through a network of aging- and disability-related organizations to help older
            Americans and people with disabilities, with the assistance of their families and caregivers, maintain their 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 a priority. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  12
                  15
                  17
               
               
                  12.1
                  Civilian personnel benefits
                  3
                  4
                  5
               
               
                  23.1
                  Rental payments to GSA
                  2
                  2
                  3
               
               
                  25.1
                  Advisory and assistance services
                  11
                  26
                  44
               
               
                  25.3
                  Other goods and services from Federal sources
                  6
                  8
                  9
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,370
                  1,590
                  1,959
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1,404
                  1,645
                  2,037
               
               
                  99.0
                  Reimbursable obligations
                  28
                  77
                  77
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,432
                  1,722
                  2,114
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â0â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  138
                  156
                  162
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  8
                  15
                  16
               
               
                  
                     
                  
               
            
         
      
         Aging and Disability Services Programs                                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0142â4â1â506
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0117
                  Aging and Disability Resource Centers (ADRC)
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  20
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  20
               
               
                  1900
                  Budget authority (total)
                  
                  
                  20
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  20
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  20
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  20
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  20
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  20
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  20
               
               
                  
                     
                  
               
            
         
      
         Departmental Management                                                                                                  
            
         Federal Funds
         General Departmental ManagementFor necessary expenses, not otherwise provided, for general departmental management, including hire of [six] passenger motor vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico
         Border Health Commission Act, and research studies under section 1110 of the Social Security Act, [$458,056,000] $286,204,000, together with [$69,211,000] $118,728,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation
         activities: Provided, That, of [this amount, $52,224,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $101,000,000 shall be for making competitive contracts and grants to
         public and private entities to fund medically accurate and age appropriate programs that reduce teen pregnancy and for the
         Federal costs associated with administering and evaluating such contracts and grants, of which not less than $72,200,000 shall
         be for replicating programs that have been proven effective through rigorous evaluation to reduce teenage pregnancy, behavioral
         risk factors underlying teenage pregnancy, or other associated risk factors, of which not less than $24,000,000 shall be available
         for research and demonstration grants to develop, replicate, refine, and test additional models and innovative strategies
         for preventing teenage pregnancy, and of which any remaining amounts shall be available for training and technical assistance,
         evaluation, outreach, and additional program support activities: Provided further, That of] the amounts provided under this heading from amounts available under section 241 of the PHS Act, [$8,455,000] $6,800,000 shall be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches, and $53,900,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, $1,750,000 is for strengthening the Department's acquisition workforce
         capacity and capabilities, including[: Provided further, That with respect to the previous proviso, such funds shall be available] for training, [recruitment] recruiting, [retention] retaining, and hiring members of the acquisition workforce as defined by 41 U.S.C. 1703, [and] for information technology in support of acquisition workforce effectiveness, [or] and for management solutions to improve acquisition management[: Provided further, That of the funds made available under this heading, $5,000,000 shall be for making competitive grants to provide abstinence
         education (as defined by section 510(b)(2)(A)-(H) of the Social Security Act) to adolescents, and for Federal costs of administering
         the grant: Provided further, That grants made under the authority of section 510(b)(2)(A)-(H) of the Social Security Act shall be made only to public
         and private entities that agree that, with respect to an adolescent to whom the entities provide abstinence education under
         such grant, the entities will not provide to that adolescent any other education regarding sexual conduct, except that, in
         the case of an entity expressly required by law to provide health information or services the adolescent shall not be precluded
         from seeking health information or services from the entity in a different setting than the setting in which abstinence education
         was provided: Provided further, That funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through
         grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4)]. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  General Departmental Management
                  447
                  458
                  286
               
               
                  0004
                  Prevention & Public Health Fund (75â0116 MAND)
                  
                  
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  447
                  458
                  391
               
               
                  0801
                  GDM (Collected)
                  173
                  158
                  158
               
               
                  0802
                  HCFAC (Mandatory)
                  9
                  9
                  15
               
               
                  0803
                  PHS Evaluation
                  69
                  69
                  119
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  251
                  236
                  292
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  698
                  694
                  683
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  
                  9
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  2
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  474
                  458
                  286
               
               
                  1120
                  Appropriations transferred to other accts [75â0943]
                  â2
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0139]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced (SEQ)
                  â25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  446
                  458
                  286
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other accts [75â0116]
                  
                  
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  105
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected [PHS Evaluation & Collected]
                  113
                  236
                  277
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  129
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  242
                  236
                  277
               
               
                  
                  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)
                  697
                  703
                  677
               
               
                  1930
                  Total budgetary resources available
                  699
                  703
                  686
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  9
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  624
                  536
                  559
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  698
                  694
                  683
               
               
                  3011
                  Obligations incurred, expired accounts
                  11
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â776
                  â671
                  â736
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  536
                  559
                  506
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â232
                  â257
                  â257
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â138
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  113
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â257
                  â257
                  â257
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  392
                  279
                  302
               
               
                  3200
                  Obligated balance, end of year
                  279
                  302
                  249
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  688
                  694
                  563
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  351
                  332
                  278
               
               
                  4011
                  Outlays from discretionary balances
                  386
                  317
                  430
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  737
                  649
                  708
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources (PHS Evaluation & Collected)
                  â224
                  â236
                  â277
               
               
                  4033
                  Non-Federal sources
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â226
                  â236
                  â277
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â129
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  113
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  446
                  458
                  286
               
               
                  4080
                  Outlays, net (discretionary)
                  511
                  413
                  431
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  9
                  9
                  114
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  9
                  9
                  23
               
               
                  4101
                  Outlays from mandatory balances
                  30
                  13
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  39
                  22
                  28
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources (HCFAC Mandatory)
                  â9
                  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
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  
                  105
               
               
                  4170
                  Outlays, net (mandatory)
                  30
                  13
                  19
               
               
                  4180
                  Budget authority, net (total)
                  446
                  458
                  391
               
               
                  4190
                  Outlays, net (total)
                  541
                  426
                  450
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
            account for 2015. Actual allocation will be determined annually.
         
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  90
                  92
                  94
               
               
                  11.3
                  Other than full-time permanent
                  14
                  13
                  12
               
               
                  11.5
                  Other personnel compensation
                  2
                  3
                  3
               
               
                  11.7
                  Military personnel
                  3
                  3
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  109
                  111
                  115
               
               
                  12.1
                  Civilian personnel benefits
                  28
                  28
                  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
                  19
                  18
                  18
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  4
                  4
                  4
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  27
                  28
                  18
               
               
                  25.2
                  Other services from non-Federal sources
                  43
                  38
                  28
               
               
                  25.3
                  Other goods and services from Federal sources
                  78
                  70
                  43
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  4
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  4
                  4
               
               
                  26.0
                  Supplies and materials
                  2
                  1
                  1
               
               
                  31.0
                  Equipment
                  2
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  120
                  145
                  120
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  447
                  458
                  391
               
               
                  99.0
                  Reimbursable obligations
                  251
                  236
                  292
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  698
                  694
                  683
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9912â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,032
                  1,051
                  1,076
               
               
                  1101
                  Direct military average strength employment
                  39
                  37
                  43
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  483
                  469
                  462
               
               
                  2101
                  Reimbursable military average strength employment
                  23
                  17
                  9
               
               
                  
                     
                  
               
            
         
      
         Office for Civil RightsFor expenses necessary for the Office for Civil Rights, [$38,798,000] 41,205,000. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â751
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  39
                  39
                  41
               
               
                  0801
                  Reimbursable program activity
                  3
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  42
                  46
                  48
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  41
                  39
                  41
               
               
                  1130
                  Appropriations permanently reduced
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  39
                  39
                  41
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  5
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  5
                  7
                  7
               
               
                  1900
                  Budget authority (total)
                  44
                  46
                  48
               
               
                  1930
                  Total budgetary resources available
                  44
                  46
                  48
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  13
                  10
                  10
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  42
                  46
                  48
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â45
                  â46
                  â48
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10
                  10
                  10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  13
                  10
                  10
               
               
                  3200
                  Obligated balance, end of year
                  10
                  10
                  10
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  39
                  39
                  41
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  34
                  31
                  33
               
               
                  4011
                  Outlays from discretionary balances
                  10
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  44
                  39
                  41
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5
                  7
                  7
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  7
                  7
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â5
                  â7
                  â7
               
               
                  4180
                  Budget authority, net (total)
                  39
                  39
                  41
               
               
                  4190
                  Outlays, net (total)
                  40
                  39
                  41
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  20
                  21
                  20
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  21
                  22
                  21
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  2
                  1
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  5
                  6
                  8
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  39
                  41
               
               
                  99.0
                  Reimbursable obligations
                  3
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  42
                  46
                  48
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0135â0â1â751
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  207
                  203
                  196
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  3
                  2
                  20
               
               
                  
                     
                  
               
            
         
      
         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, [$15,556,000: Provided, That in addition to amounts provided herein, $44,811,000] $74,688,000 shall be available from amounts available under section 241 of the PHS Act. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health information technology
                  16
                  16
                  
               
               
                  0002
                  Recovery Act activities
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  20
                  16
                  
               
               
                  0801
                  Reimbursable program
                  15
                  24
                  17
               
               
                  0802
                  Reimbursable program: PHS evaluation
                  45
                  45
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  60
                  69
                  92
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  80
                  85
                  92
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  16
                  16
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â1
                  
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  14
                  16
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  PHS and Other
                  26
                  69
                  92
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  34
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  60
                  69
                  92
               
               
                  1900
                  Budget authority (total)
                  74
                  85
                  92
               
               
                  1930
                  Total budgetary resources available
                  80
                  85
                  92
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  976
                  451
                  53
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  80
                  85
                  92
               
               
                  3020
                  Outlays (gross)
                  â598
                  â483
                  â145
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  451
                  53
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â22
                  â34
                  â34
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â34
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â34
                  â34
                  â34
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  954
                  417
                  19
               
               
                  3200
                  Obligated balance, end of year
                  417
                  19
                  â34
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  74
                  85
                  92
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  48
                  83
                  92
               
               
                  4011
                  Outlays from discretionary balances
                  548
                  400
                  53
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  596
                  483
                  145
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â47
                  â69
                  â92
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â34
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  14
                  16
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  549
                  414
                  53
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  14
                  16
                  
               
               
                  4190
                  Outlays, net (total)
                  551
                  414
                  53
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  
               
               
                  25.1
                  Advisory and assistance services
                  
                  1
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  10
                  6
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  5
                  5
                  
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  20
                  16
                  
               
               
                  99.0
                  Reimbursable obligations
                  60
                  69
                  92
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  80
                  85
                  92
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0130â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  170
                  184
                  190
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Office of Medicare Hearings and AppealsFor expenses necessary for the Office of Medicare Hearings and Appeals, [$82,381,000] $100,000,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
         Insurance Trust Fund. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  69
                  82
                  100
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other accts [75â9912]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other accts [75â0140]
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2
                  
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  45
                  82
                  100
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  68
                  82
                  100
               
               
                  1900
                  Budget authority (total)
                  70
                  82
                  100
               
               
                  1930
                  Total budgetary resources available
                  70
                  83
                  101
               
               
                  
                  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
                  14
                  9
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  69
                  82
                  100
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â73
                  â91
                  â100
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â23
                  â23
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â23
                  â23
                  â23
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  14
                  â14
                  â23
               
               
                  3200
                  Obligated balance, end of year
                  â14
                  â23
                  â23
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  70
                  82
                  100
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  65
                  82
                  100
               
               
                  4011
                  Outlays from discretionary balances
                  8
                  9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  73
                  91
                  100
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â45
                  â82
                  â100
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  2
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  28
                  9
                  
               
               
                  4180
                  Budget authority, net (total)
                  2
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  28
                  9
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  40
                  45
                  55
               
               
                  12.1
                  Civilian personnel benefits
                  12
                  14
                  17
               
               
                  22.0
                  Transportation of things
                  
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  6
                  7
                  7
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  3
                  4
                  4
               
               
                  25.1
                  Advisory and assistance services
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  5
                  5
                  7
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  3
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  
                  1
                  1
               
               
                  31.0
                  Equipment
                  
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  69
                  82
                  100
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0139â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  492
                  514
                  629
               
               
                  
                     
                  
               
            
         
      
         Public Health and Social Services Emergency FundFor 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, [$857,290,000] $837,927,000, of which [$415,000,000] $415,000,000 shall remain available through September 30, [2015] 2016, 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.] until expended: Provided further, That, of the amounts made available to support advanced research and development, up to
            $20,000,000 shall be available 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, which shall not be deemed to be a Federal agency for any purpose, to further the purposes of such
            section 319L to foster innovation in the development of medical countermeasures: Provided further, That, in addition to amounts
            provided herein, $14,877,000 shall be available from amounts available under section 241 of the PHS Act to supplement funds
            otherwise available for carrying out activities of the Office of the Assistant Secretary for Preparedness and Response. 
      For [necessary] expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act), [$255,000,000] $415,000,000, to remain available until expended.
      
      For an additional amount for expenses necessary to prepare for [and] or respond to an influenza pandemic[, $115,009,000] or emerging infectious disease, including the development and purchase of vaccine, antivirals, necessary medical supplies,
            diagnostics, and other surveillance tools, $170,009,000; of which [$83,000,000] $140,000,000 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. 
      [In addition, for expenses necessary for replacement of building leases and associated renovation costs for Public Health Service
         agencies and other components of HHS, including relocation and fit-out costs, $16,131,000, to remain available until expended.] (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Public Health and Social Services Emergency Fund
                  2,326
                  1,319
                  1,541
               
               
                  0801
                  Reimbursable program (FEMA)
                  44
                  80
                  80
               
               
                  0802
                  Reimbursable program activity (OPP)
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  44
                  80
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,370
                  1,399
                  1,636
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,349
                  850
                  771
               
               
                  1010
                  Unobligated balance transfer to other accts [75â0343]
                  â3
                  â3
                  â3
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  238
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,584
                  847
                  768
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,385
                  1,243
                  1,423
               
               
                  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
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â9915]
                  â149
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0943]
                  â2
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [75â0139]
                  â1
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â40
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  588
                  1,243
                  1,423
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  27
                  80
                  95
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  57
                  80
                  95
               
               
                  1900
                  Budget authority (total)
                  645
                  1,323
                  1,518
               
               
                  1930
                  Total budgetary resources available
                  3,229
                  2,170
                  2,286
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â9
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  850
                  771
                  650
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,456
                  4,655
                  4,190
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,370
                  1,399
                  1,636
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,880
                  â1,864
                  â2,000
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â238
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â55
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,655
                  4,190
                  3,826
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â241
                  â153
                  â153
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  118
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â153
                  â153
                  â153
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4,215
                  4,502
                  4,037
               
               
                  3200
                  Obligated balance, end of year
                  4,502
                  4,037
                  3,673
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  645
                  1,323
                  1,518
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  177
                  439
                  445
               
               
                  4011
                  Outlays from discretionary balances
                  1,703
                  1,425
                  1,555
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,880
                  1,864
                  2,000
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â111
                  â80
                  â95
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  84
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  54
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  588
                  1,243
                  1,423
               
               
                  4080
                  Outlays, net (discretionary)
                  1,769
                  1,784
                  1,905
               
               
                  4180
                  Budget authority, net (total)
                  588
                  1,243
                  1,423
               
               
                  4190
                  Outlays, net (total)
                  1,769
                  1,784
                  1,905
               
               
                  
                     
                  
               
            
         
      
      
         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, as authorized by the Pandemic and All-Hazards Preparedness
            Reauthorization 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 Cybersecurity 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 estabished to invest in the private sector, specifically focusing on disruptive technologies
            including novel antimicrobials and multi-use platform technologies for diagnostics and medical countermeasures.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  67
                  69
                  73
               
               
                  11.3
                  Other than full-time permanent
                  8
                  8
                  8
               
               
                  11.7
                  Military personnel
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  82
                  84
                  88
               
               
                  12.1
                  Civilian personnel benefits
                  21
                  22
                  23
               
               
                  12.2
                  Military personnel benefits
                  3
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  8
                  7
                  7
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  18
                  18
                  18
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  4
                  8
                  10
               
               
                  25.1
                  Advisory and assistance services
                  414
                  210
                  297
               
               
                  25.2
                  Other services from non-Federal sources
                  249
                  138
                  131
               
               
                  25.3
                  Other goods and services from Federal sources
                  72
                  54
                  58
               
               
                  25.4
                  Operation and maintenance of facilities
                  22
                  23
                  25
               
               
                  25.5
                  Research and development contracts
                  241
                  104
                  146
               
               
                  25.7
                  Operation and maintenance of equipment
                  30
                  26
                  28
               
               
                  26.0
                  Supplies and materials
                  685
                  340
                  377
               
               
                  31.0
                  Equipment
                  20
                  16
                  17
               
               
                  41.0
                  Grants, subsidies, and contributions
                  456
                  265
                  312
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,326
                  1,319
                  1,541
               
               
                  99.0
                  Reimbursable obligations
                  44
                  80
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,370
                  1,399
                  1,636
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0140â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  600
                  665
                  689
               
               
                  1101
                  Direct military average strength employment
                  63
                  76
                  76
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust Fund                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  AHRQ
                  44
                  68
                  120
               
               
                  0802
                  Office of the Secretary
                  7
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  51
                  93
                  145
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  51
                  93
                  145
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  28
                  49
                  92
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  72
                  136
                  132
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  72
                  136
                  132
               
               
                  1900
                  Budget authority (total)
                  72
                  136
                  132
               
               
                  1930
                  Total budgetary resources available
                  100
                  185
                  224
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  49
                  92
                  79
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  9
                  49
                  108
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  51
                  93
                  145
               
               
                  3020
                  Outlays (gross)
                  â11
                  â34
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  49
                  108
                  183
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  9
                  49
                  108
               
               
                  3200
                  Obligated balance, end of year
                  49
                  108
                  183
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  72
                  136
                  132
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  4
                  4
               
               
                  4101
                  Outlays from mandatory balances
                  10
                  30
                  66
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  11
                  34
                  70
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â72
                  â136
                  â132
               
               
                  4190
                  Outlays, net (total)
                  â61
                  â102
                  â62
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  7
                  25
                  25
               
               
                  
                  Allocation Account - reimbursable:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  2
                  3
               
               
                  25.5
                  Research and development contracts
                  44
                  25
                  28
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  41
                  89
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Allocation account - reimbursable
                  44
                  68
                  120
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  51
                  93
                  145
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0145â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Prevention and Wellness Fund, Recovery Act                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0144â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Prevention and Wellness Fund is authorized under the American Recovery and Reinvestment Act (ARRA), (P.L. 111â5). The
            Prevention and Wellness Fund administered evidence-based clinical and community-based prevention and wellness strategies.
         
      
         Nonrecurring Expenses Fund                                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0125â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Nonrecurring Expenses Fund Projects
                  578
                  550
                  50
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  285
                  50
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  863
                  315
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  863
                  600
                  50
               
               
                  1930
                  Total budgetary resources available
                  863
                  600
                  50
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  285
                  50
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  505
                  539
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  578
                  550
                  50
               
               
                  3020
                  Outlays (gross)
                  â73
                  â516
                  â178
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  505
                  539
                  411
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  505
                  539
               
               
                  3200
                  Obligated balance, end of year
                  505
                  539
                  411
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  73
                  516
                  178
               
               
                  4190
                  Outlays, net (total)
                  73
                  516
                  178
               
               
                  
                     
                  
               
            
         
      
      
         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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0125â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  45
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  88
                  
                  
               
               
                  25.7
                  Operation and maintenance of equipment
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  97
                  45
                  
               
               
                  25.2
                  Allocation Account - direct: Other services from non-Federal sources
                  481
                  505
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  578
                  550
                  50
               
               
                  
                     
                  
               
            
         
      
         Health Insurance Reform Implementation Fund                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0119â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  160
                  87
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  240
                  87
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  247
                  87
                  
               
               
                  1930
                  Total budgetary resources available
                  247
                  87
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  87
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  265
                  197
                  121
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  160
                  87
                  
               
               
                  3020
                  Outlays (gross)
                  â221
                  â163
                  â100
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  197
                  121
                  21
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  265
                  197
                  121
               
               
                  3200
                  Obligated balance, end of year
                  197
                  121
                  21
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  221
                  163
                  100
               
               
                  4190
                  Outlays, net (total)
                  221
                  163
                  100
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  25.2
                  Direct obligations: Other services from non-Federal sources
                  158
                  25
                  
               
               
                  
                  Allocation Account - direct:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  62
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Allocation account - direct
                  
                  62
                  
               
               
                  99.5
                  Below reporting threshold
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  160
                  87
                  
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0116â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,000
                  1,000
                  1,000
               
               
                  1220
                  Appropriations transferred to other accts [75â0142]
                  â9
                  â28
                  â28
               
               
                  1220
                  Appropriations transferred to other accts [75â1700]
                  â6
                  â7
                  
               
               
                  1220
                  Appropriations transferred to other accts [75â0943]
                  â463
                  â831
                  â809
               
               
                  1220
                  Appropriations transferred to other accts [75â0511]
                  â454
                  
                  
               
               
                  1220
                  Appropriations transferred to other accts [75â0350]
                  â2
                  
                  
               
               
                  1220
                  Appropriations transferred to other accts [75â1362]
                  â15
                  â62
                  â58
               
               
                  1220
                  Appropriations transferred to other accts [75â9912]
                  
                  
                  â105
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â51
                  â72
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Affordable Care Act, (P.L. 111â148) established the Prevention and Public Health Fund to support prevention and public
            health activities. In FY 2015, $1.00 billion is available 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.
         
      
         Pregnancy Assistance Fund                                                                                                
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  24
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  25
                  25
                  25
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  24
                  23
                  25
               
               
                  1930
                  Total budgetary resources available
                  24
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  39
                  34
                  42
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  24
                  23
                  25
               
               
                  3020
                  Outlays (gross)
                  â29
                  â15
                  â24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  34
                  42
                  43
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  39
                  34
                  42
               
               
                  3200
                  Obligated balance, end of year
                  34
                  42
                  43
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  24
                  23
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  2
                  2
               
               
                  4101
                  Outlays from mandatory balances
                  28
                  13
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  29
                  15
                  24
               
               
                  4180
                  Budget authority, net (total)
                  24
                  23
                  25
               
               
                  4190
                  Outlays, net (total)
                  29
                  15
                  24
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  23
                  22
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  24
                  23
                  25
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0117â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  2
               
               
                  
                     
                  
               
            
         
      
         Section 241 Evaluation Transactions Account                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â3902â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  1,060
                  1,264
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  
                  1,060
                  1,264
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.3)
                  
                  1,060
                  1,264
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  1,060
                  1,264
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  
                  1,060
                  1,264
               
               
                  1930
                  Total budgetary resources available
                  
                  1,060
                  1,264
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  1,060
                  1,264
               
               
                  3020
                  Outlays (gross)
                  
                  â1,060
                  â1,264
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  1,060
                  1,264
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  1,060
                  1,264
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  
                  â1,060
                  â1,264
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  1,060
                  1,264
               
               
                  
                     
                  
               
            
         
      
         Program Support Center                                                                                                   
            
         Federal Funds
         Retirement Pay and Medical Benefits for Commissioned OfficersFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
         under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
         personnel under the Dependents' Medical Care Act, such amounts as may be required during the current fiscal year. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0379â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Retirement payments
                  393
                  414
                  432
               
               
                  0002
                  Survivors' benefits
                  26
                  27
                  28
               
               
                  0003
                  Medical care
                  95
                  99
                  102
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  514
                  540
                  562
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  514
                  540
                  562
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  514
                  540
                  562
               
               
                  1930
                  Total budgetary resources available
                  514
                  540
                  562
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  101
                  67
                  30
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  â31
                  
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  514
                  540
                  562
               
               
                  3020
                  Outlays (gross)
                  â497
                  â577
                  â561
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  67
                  30
                  31
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  70
                  67
                  30
               
               
                  3200
                  Obligated balance, end of year
                  67
                  30
                  31
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  514
                  540
                  562
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  453
                  513
                  534
               
               
                  4101
                  Outlays from mandatory balances
                  44
                  64
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  497
                  577
                  561
               
               
                  4180
                  Budget authority, net (total)
                  514
                  540
                  562
               
               
                  4190
                  Outlays, net (total)
                  497
                  577
                  561
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2013
                     2014
                     2015
                  
                  
                     
                        
                     
                  
                  
                     Active Duty:
                     
                     
                     
                  
                  
                     HHS
                     4964
                     4985
                     4985
                  
                  
                     DOJ, BOP
                     866
                     870
                     870
                  
                  
                     Homeland Security
                     494
                     494
                     494
                  
                  
                     EPA
                     65
                     65
                     65
                  
                  
                     All Other
                     376
                     384
                     384
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Active Duty
                     6765
                     6798
                     6798
                  
                  
                     
                     
                     
                     
                  
                  
                     Retirees & Survivors:
                     
                     
                     
                  
                  
                     Retirees
                     5714
                     5860
                     6010
                  
                  
                     Retiree family members and survivors
                     1029
                     1058
                     1088
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Retirement Pay
                     6743
                     6918
                     7098
                  
                  
                     Total Beneficiaries (active duty, retirees, survivors)
                     13508
                     13716
                     13896
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  13.0
                  Benefits for former personnel
                  419
                  441
                  460
               
               
                  25.6
                  Medical care
                  95
                  99
                  102
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  514
                  540
                  562
               
               
                  
                     
                  
               
            
         
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  28
                  27
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  28
                  27
                  28
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  29
                  27
                  28
               
               
                  1130
                  Appropriations permanently reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  28
                  27
                  28
               
               
                  1930
                  Total budgetary resources available
                  28
                  27
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  28
                  27
                  28
               
               
                  3020
                  Outlays (gross)
                  â28
                  â27
                  â28
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  28
                  27
                  28
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  28
                  27
                  28
               
               
                  4180
                  Budget authority, net (total)
                  28
                  27
                  28
               
               
                  4190
                  Outlays, net (total)
                  28
                  27
                  28
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  28
                  27
                  28
               
               
                  
                  Outlays
                  28
                  27
                  28
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â3
               
               
                  
                  Outlays
                  
                  
                  â3
               
               
                  Total:
               
               
                  
                  Budget Authority
                  28
                  27
                  25
               
               
                  
                  Outlays
                  28
                  27
                  25
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  
                  
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  
                  
                  â3
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â3
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â3
               
               
                  3020
                  Outlays (gross)
                  
                  
                  3
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â3
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â3
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â3
               
               
                  
                     
                  
               
            
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9913â0â1â552
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  1
                  1
               
               
                  1930
                  Total budgetary resources available
                  1
                  1
                  1
               
               
                  
                  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
                  1
                  
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Program Support Center
                  654
                  796
                  785
               
               
                  0802
                  OS activities
                  300
                  351
                  359
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  954
                  1,147
                  1,144
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  102
                  117
                  73
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  97
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  199
                  117
                  73
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  916
                  1,103
                  1,103
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â44
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  872
                  1,103
                  1,103
               
               
                  1930
                  Total budgetary resources available
                  1,071
                  1,220
                  1,176
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  117
                  73
                  32
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  510
                  515
                  70
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  954
                  1,147
                  1,144
               
               
                  3020
                  Outlays (gross)
                  â852
                  â1,592
                  â1,103
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â97
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  515
                  70
                  111
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â285
                  â241
                  â241
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  44
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â241
                  â241
                  â241
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  225
                  274
                  â171
               
               
                  3200
                  Obligated balance, end of year
                  274
                  â171
                  â130
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  872
                  1,103
                  1,103
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  568
                  1,103
                  1,103
               
               
                  4011
                  Outlays from discretionary balances
                  284
                  489
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  852
                  1,592
                  1,103
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â911
                  â1,103
                  â1,103
               
               
                  4033
                  Non-Federal sources
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â916
                  â1,103
                  â1,103
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  44
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â64
                  489
                  
               
               
                  4190
                  Outlays, net (total)
                  â64
                  489
                  
               
               
                  
                     
                  
               
            
         
      
      
         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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  92
                  103
                  103
               
               
                  11.3
                  Other than full-time permanent
                  4
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  2
                  3
                  3
               
               
                  11.7
                  Military personnel
                  7
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  105
                  116
                  116
               
               
                  12.1
                  Civilian personnel benefits
                  28
                  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
                  22
                  22
                  22
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  34
                  6
                  6
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  29
                  32
                  31
               
               
                  25.2
                  Other services from non-Federal sources
                  554
                  706
                  707
               
               
                  25.3
                  Other goods and services from Federal sources
                  52
                  71
                  70
               
               
                  25.4
                  Operation and maintenance of facilities
                  13
                  16
                  16
               
               
                  25.6
                  Medical care
                  20
                  29
                  29
               
               
                  25.7
                  Operation and maintenance of equipment
                  60
                  74
                  73
               
               
                  26.0
                  Supplies and materials
                  24
                  32
                  32
               
               
                  31.0
                  Equipment
                  1
                  3
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  954
                  1,147
                  1,144
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9941â0â4â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,071
                  1,238
                  1,238
               
               
                  2101
                  Reimbursable military average strength employment
                  83
                  88
                  86
               
               
                  3101
                  Allocation account military average strength employment
                  1,736
                  1,748
                  1,748
               
               
                  
                     
                  
               
            
         
      
      Trust Funds
         Miscellaneous Trust Funds                                                                                                
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  32
               
               
                  
                  Receipts:
               
               
                  0220
                  Contributions, Indian Health Facilities
                  12
                  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
                  31
                  27
                  27
               
               
                  0224
                  Contributions to the Indian Health Service Gift Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0299
                  Total receipts and collections
                  62
                  94
                  94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total: Balances and collections
                  62
                  94
                  126
               
               
                  
                  Appropriations:
               
               
                  0500
                  Miscellaneous Trust Funds
                  â62
                  â62
                  â63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Balance, end of year
                  
                  32
                  63
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Gifts
                  39
                  39
                  39
               
               
                  0003
                  Contributions, Indian Health Facilities
                  12
                  12
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  51
                  51
                  51
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  133
                  149
                  160
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  138
                  149
                  160
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  62
                  62
                  63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  62
                  62
                  63
               
               
                  1930
                  Total budgetary resources available
                  200
                  211
                  223
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  149
                  160
                  172
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  75
                  67
                  66
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  51
                  51
                  51
               
               
                  3020
                  Outlays (gross)
                  â54
                  â52
                  â57
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  67
                  66
                  60
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  75
                  67
                  66
               
               
                  3200
                  Obligated balance, end of year
                  67
                  66
                  60
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  62
                  62
                  63
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  22
                  5
                  6
               
               
                  4101
                  Outlays from mandatory balances
                  32
                  47
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  54
                  52
                  57
               
               
                  4180
                  Budget authority, net (total)
                  62
                  62
                  63
               
               
                  4190
                  Outlays, net (total)
                  54
                  52
                  57
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  25
                  28
                  28
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  28
                  28
                  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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  2
                  2
                  2
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  3
                  3
                  3
               
               
                  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
                  6
                  6
                  6
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  7
                  7
               
               
                  25.5
                  Research and development contracts
                  7
                  7
                  7
               
               
                  25.6
                  Medical care
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  5
                  4
                  4
               
               
                  31.0
                  Equipment
                  5
                  6
                  6
               
               
                  41.0
                  Grants, subsidies, and contributions
                  12
                  12
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  51
                  51
                  51
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â9971â0â7â551
                  2013 actual
                  2014 est.
                  2015 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, [$71,000,000] $75,000,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary and investigating
         non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228. (Department of Health and Human Services Appropriations Act, 2014.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program
                  49
                  74
                  78
               
               
                  0801
                  HCFAC Reimbursable program
                  213
                  197
                  197
               
               
                  0802
                  Direct Reimbursable program
                  18
                  21
                  21
               
               
                  0803
                  HCFAC Discretionary allocation adjustment
                  39
                  30
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  270
                  248
                  241
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  319
                  322
                  319
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  10
                  21
                  16
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  
                  7
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  10
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  24
                  21
                  16
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  50
                  71
                  75
               
               
                  1121
                  Appropriations transferred from other accts [75â0140]
                  5
                  
                  
               
               
                  1130
                  Appropriations permanently reduced
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  52
                  71
                  75
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  51
                  49
                  49
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  60
                  49
                  49
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  224
                  197
                  212
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â20
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  
                  1
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  204
                  197
                  212
               
               
                  1900
                  Budget authority (total)
                  316
                  317
                  336
               
               
                  1930
                  Total budgetary resources available
                  340
                  338
                  352
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  21
                  16
                  33
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  57
                  35
                  45
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  319
                  322
                  319
               
               
                  3011
                  Obligations incurred, expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â333
                  â312
                  â342
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â4
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  35
                  45
                  22
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â61
                  â35
                  â35
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  11
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â35
                  â35
                  â35
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â4
                  
                  10
               
               
                  3200
                  Obligated balance, end of year
                  
                  10
                  â13
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  112
                  120
                  124
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  82
                  114
                  117
               
               
                  4011
                  Outlays from discretionary balances
                  29
                  6
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  111
                  120
                  125
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â68
                  â49
                  â49
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  52
                  71
                  75
               
               
                  4080
                  Outlays, net (discretionary)
                  43
                  71
                  76
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  204
                  197
                  212
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  184
                  179
                  193
               
               
                  4101
                  Outlays from mandatory balances
                  38
                  13
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  222
                  192
                  217
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â214
                  â185
                  â200
               
               
                  4123
                  Non-Federal sources
                  â10
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â224
                  â197
                  â212
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  20
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â2
                  â5
                  5
               
               
                  4180
                  Budget authority, net (total)
                  52
                  71
                  75
               
               
                  4190
                  Outlays, net (total)
                  41
                  66
                  81
               
               
                  
                     
                  
               
            
         
      
      
         The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
            Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
            1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
            and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
            HHS programs well serve the people that use them. 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
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  26
                  40
                  42
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  27
                  41
                  43
               
               
                  12.1
                  Civilian personnel benefits
                  9
                  14
                  15
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  10
                  11
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  49
                  74
                  78
               
               
                  99.0
                  Reimbursable obligations
                  270
                  248
                  241
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  319
                  322
                  319
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â0â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  245
                  379
                  397
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,415
                  1,198
                  1,048
               
               
                  
                     
                  
               
            
         
      
         Office of Inspector General                                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  
                  85
               
               
                  
                     
                  
               
               
                  
                  Budgetary Resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  85
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  
                  
                  85
               
               
                  1900
                  Budget authority (total)
                  
                  
                  85
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  85
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  85
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â85
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  85
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  85
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â85
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  85
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 75â0128â4â1â551
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  416
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions                                                                                    
            
         
         GENERAL FUND RECEIPT ACCOUNTS                                                                                            
            
         (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2013 actual
                  2014 est.
                  2015 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  75â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified: Enacted/requested
                  173
                  90
                  90
               
               
                  75â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies: Enacted/requested
                  
                  6
                  
               
               
                  75â274530
                  Health Education Assistance Loans, Downward Reestimates of Subsidies: Enacted/requested
                  
                  43
                  
               
               
                  75â310700
                  Federal Share of Child Support Collections: Enacted/requested
                  841
                  759
                  700
               
               
                  Legislative proposal, subject to PAYGO
                  
                  
                  5
               
               
                  75â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts: Enacted/requested
                  41
                  34
                  34
               
               
                  General Fund Offsetting receipts from the public
                  1,055
                  932
                  829
               
               
                  
                     
                  
               
               
                  
               
               
                  Intragovernmental payments:
               
               
                  75â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts: Enacted/requested
                  1,147
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  1,147
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         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 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. None of the funds appropriated in this Act may be expended pursuant to section 241 of the PHS Act, except for funds specifically
      provided for in this Act, or for other taps and assessments made by any office located in HHS, prior to the preparation and
      submission of a report by the Secretary to the Committees on Appropriations of the House of Representatives and the Senate
      detailing the planned uses of such funds.SEC. [205]204. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than [2.5] 3.0 percent, of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly,
      or by grants or contracts) and the implementation and effectiveness of programs funded in this title.'
      			
      (transfer of funds)SEC. [206]205. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
      which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
      appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [207]206. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. [208]207. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research'' account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. [209]208. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. [210]209. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. [211]210. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
      Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
      Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
      provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. [212]211. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year [2014] 2015:
      (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
         Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
         that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
         of 1980 and other applicable statutes administered by the Department of State.
      
      (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
         to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
         for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
         functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
         and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
         through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
         foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
         of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
         chronic and environmental diseases, and other health activities abroad.
      
      (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
         benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
         4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
         comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
         percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
         official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
         the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
         Service Act of 1980, to individuals serving in the Foreign Service.
      SEC. [213]212. (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director'') may use funds available under section 402(b)(7)
      or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
      out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
      in such section 402(b)(12).
      (b) Peer Review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      SEC. [214]213. Funds which are available for Individual Learning Accounts for employees of CDC and the Agency for Toxic Substances and Disease
      Registry ("ATSDR'') may be transferred [to] between appropriate accounts of CDC, to be available only for Individual Learning Accounts: Provided, That such funds may be used for any individual full-time equivalent employee while such employee is employed either by CDC
      or ATSDR.SEC. [215]214. 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. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.][SEC. 218. (a) The Secretary shall establish a publicly accessible Web site to provide information regarding the uses of funds made available
      under section 4002 of the Patient Protection and Affordable Care Act of 2010 ("ACA'').
      (b) With respect to funds provided under section 4002 of the ACA, the Secretary shall include on the Web site established under
         subsection (a) at a minimum the following information:
         (1) In the case of each transfer of funds under section 4002(c), a statement indicating the program or activity receiving funds,
            the operating division or office that will administer the funds, and the planned uses of the funds, to be posted not later
            than the day after the transfer is made.
         
         (2) Identification (along with a link to the full text) of each funding opportunity announcement, request for proposals, or other
            announcement or solicitation of proposals for grants, cooperative agreements, or contracts intended to be awarded using such
            funds, to be posted not later than the day after the announcement or solicitation is issued.
         
         (3) Identification of each grant, cooperative agreement, or contract with a value of $25,000 or more awarded using such funds,
            including the purpose of the award and the identity of the recipient, to be posted not later than 5 days after the award is
            made.
         
         (4) A report detailing the uses of all funds transferred under section 4002(c) during the fiscal year, to be posted not later
            than 90 days after the end of the fiscal year.
         
      
      (c) With respect to awards made in fiscal years 2013 and 2014, the Secretary shall also include on the Web site established under
         subsection (a), semi-annual reports from each entity awarded a grant, cooperative agreement, or contract from such funds with
         a value of $25,000 or more, summarizing the activities undertaken and identifying any sub-grants or sub-contracts awarded
         (including the purpose of the award and the identity of the recipient), to be posted not later than 30 days after the end
         of each 6-month period.
      
      (d) In carrying out this section, the Secretary shall:
         (1) present the information required in subsection (b)(1) on a single webpage or on a single database;
         (2) ensure that all information required in this section is directly accessible from the single webpage or database; and
         (3) ensure that all information required in this section is able to be organized by program or State.]
      '
      			
      (transfer of funds)[SEC. 219. (a) Within 45 days of enactment of this Act, the Secretary shall transfer funds appropriated under section 4002 of the Patient
      Protection and Affordable Care Act of 2010 ("ACA'') to the accounts specified, in the amounts specified, and for the activities
      specified under the heading "Prevention and Public Health Fund'' in the explanatory statement described in section 4 (in the
      matter preceding division A of this Consolidated Act) accompanying this Act.
      (b) Notwithstanding section 4002(c) of the ACA, the Secretary may not further transfer these amounts.
      (c) Funds transferred for activities authorized under section 2821 of the PHS Act shall be made available without reference to
         section 2821(b) of such Act.]SEC. [220]216. (a) The Biomedical Advanced Research and Development Authority ("BARDA'') may enter into a contract, for more than one but no
      more than 10 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 PHS 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.
      [SEC. 221. (a) The Secretary shall publish in the fiscal year 2015 budget justification and on Departmental Web sites information concerning
      the employment of full-time equivalent Federal employees or contractors for the purposes of implementing, administering, enforcing,
      or otherwise carrying out the provisions of the Patient Protection and Affordable Care Act of 2010 ("ACA''), and the amendments
      made by that Act, in the proposed fiscal year and the 4 prior fiscal years.
      (b) With respect to employees or contractors supported by all funds appropriated for purposes of carrying out the ACA (and the
         amendments made by that Act), the Secretary shall include, at a minimum, the following information:
         (1) For each such fiscal year, the section of such Act under which such funds were appropriated, a statement indicating the program,
            project, or activity receiving such funds, the Federal operating division or office that administers such program, and the
            amount of funding received in discretionary or mandatory appropriations.
         
         (2) For each such fiscal year, the number of full-time equivalent employees or contracted employees assigned to each authorized
            and funded provision detailed in accordance with paragraph (1).
         
      
      (c) In carrying out this section, the Secretary may exclude from the report employees or contractors who:
         (1) Are supported through appropriations enacted in laws other than the ACA and work on programs that existed prior to the passage
            of the ACA;
         
         (2) spend less than 50 percent of their time on activities funded by or newly authorized in the ACA;
         (3) or who work on contracts for which FTE reporting is not a requirement of their contract, such as fixed-price contracts.]
      [SEC. 222. In addition to the amounts otherwise available for "Centers for Medicare and Medicaid Services, Program Management'', the
      Secretary of Health and Human Services may transfer up to $305,000,000 to such account from the Federal Hospital Insurance
      Trust Fund and the Federal Supplementary Medical Insurance Trust Fund to support program management activity related to the
      Medicare Program: Provided, That except for the foregoing purpose, such funds may not be used to support any provision of Public Law 111â148 or Public
      Law 111â152 (or any amendment made by either such Public Law) or to supplant any other amounts within such account.]SEC. [223]217. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act, terminations described in such section may occur
      up to 60 days after the execution of a contract awarded in fiscal year [2014] 2015 under section 338B of such Act.[SEC. 224. The Secretary shall publish, as part of the fiscal year 2015 budget of the President submitted under section 1105(a) of title
      31, United States Code, information that details the uses of all funds used by the Centers for Medicare and Medicaid Services
      specifically for Health Insurance Marketplaces for each fiscal year since the enactment of the Patient Protection and Affordable
      Care Act (Public Law 111â148) and the proposed uses for such funds for fiscal year 2015. Such information shall include, for
      each such fiscal yearâ
      (1) the section(s) of such Act under which such funds were appropriated or used;
      (2) the program, project, or activity for which such funds were used;
      (3) the amount of funds that were used for the Health Insurance Marketplaces within each such program, project, or activity; and
      (4) the milestones completed for data hub functionality and implementation readiness.][SEC. 225. Activities authorized under part A of title IV and section 1108(b) of the Social Security Act (except for activities authorized
      in section 403(b)) shall continue through September 30, 2014, in the manner authorized for fiscal year 2013, and out of any
      money in the Treasury of the United States not otherwise appropriated, there are hereby appropriated such sums as may be necessary
      for such purpose.][SEC. 226. The Secretary shall include in the fiscal year 2016 budget justification an analysis of how section 2713 of the PHS Act will
      impact eligibility for discretionary HHS programs.]SEC. 218.  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  (Department of Health and Human Services Appropriations Act, 2014.)