[Appendix]
[Detailed Budget Estimates by Agency]
[Department of Health and Human Services]
[From the U.S. Government Publishing 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; [$4,681,392,000] $4,755,944,000: Provided, That of the amount provided under this heading, [$851,481,000] $865,653,000 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; [$137,677,000] $144,859,000 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; [$318,363,000] $324,085,000 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; [$21,540,000] $22,079,000 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; [$22,818,000] $22,977,000 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; [$9,705,000] $10,367,000 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; [$599,000,000] $635,000,000 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: Provided further, That in addition to 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 [2016] 2017 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 [2016] 2017, including any such fees collected prior to fiscal year [2016] 2017 but credited for fiscal year [2016] 2017, shall be subject to the fiscal year [2016] 2017 limitations: Provided further, That the Secretary may accept payment during fiscal year [2016] 2017 of user fees specified under this heading and authorized for fiscal year [2017] 2018, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year [2017] 2018 for which the Secretary accepts payment in fiscal year [2016] 2017 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) $987,328,000 shall be for the Center for Food Safety and Applied Nutrition and
         related field activities in the Office of Regulatory Affairs; (2) $1,394,136,000 shall be for the Center for Drug Evaluation
         and Research and related field activities in the Office of Regulatory Affairs; (3) $354,901,000 shall be for the Center for
         Biologics Evaluation and Research and for related field activities in the Office of Regulatory Affairs; (4) $187,825,000 shall
         be for the Center for Veterinary Medicine and for related field activities in the Office of Regulatory Affairs; (5) $430,443,000
         shall be for the Center for Devices and Radiological Health and for related field activities in the Office of Regulatory Affairs;
         (6) $63,331,000 shall be for the National Center for Toxicological Research; (7) $564,117,000 shall be for the Center for
         Tobacco Products and for related field activities in the Office of Regulatory Affairs; (8) not to exceed $171,418,000 shall
         be for Rent and Related activities, of which $52,346,000 is for White Oak Consolidation, other than the amounts paid to the
         General Services Administration for rent; (9) not to exceed $238,274,000 shall be for payments to the General Services Administration
         for rent; and (10) $289,619,000 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 of the amounts that are made available under this heading for "other activities", and that are not derived from user
         fees, $1,500,000 shall be transferred to and merged with the appropriation for "Department of Health and Human ServicesâOffice
         of Inspector General" for oversight of the programs and operations of the Food and Drug Administration and shall be in addition
         to funds otherwise made available for oversight of the Food and Drug Administration:] 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,
         priority review user fees authorized by 21 U.S.C. 360n and 360ff, 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 distributor 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), and third-party auditor
         fees authorized by 21 U.S.C. 384d(c)(8), shall be credited to this account, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2016.)
         Buildings and facilitiesFor plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities of or used by the Food and Drug Administration, where not otherwise provided,
         [$8,788,000] $11,788,000, to remain available until expended. (Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act, 2016.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  1
                  1
                  2
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Cooperative Research and Development Agreements, FDA
                  2
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  3
                  4
                  5
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Salaries and Expenses
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  1
                  2
                  3
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foods
                  903
                  987
                  1,013
               
               
                  0002
                  Drugs
                  482
                  492
                  492
               
               
                  0003
                  Devices and Radiological Products
                  321
                  323
                  326
               
               
                  0004
                  National Center for Toxicological Research
                  63
                  63
                  60
               
               
                  0005
                  Other Activities
                  173
                  182
                  178
               
               
                  0006
                  Other Rent and Rent Related Activities
                  116
                  121
                  115
               
               
                  0007
                  Rental Payments
                  169
                  177
                  170
               
               
                  0008
                  Buildings and Facilities
                  9
                  9
                  12
               
               
                  0009
                  CRADAs
                  2
                  2
                  2
               
               
                  0010
                  Animal Drugs and Feed
                  147
                  159
                  162
               
               
                  0011
                  Biologics
                  211
                  215
                  215
               
               
                  0012
                  Food and Drug Safety (no-year)
                  12
                  
                  
               
               
                  0013
                  Ebola (Emergency pursuant to 2011 BCA)
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  2,619
                  2,730
                  2,745
               
               
                  0801
                  Reimbursable program (User fees)
                  1,898
                  2,009
                  2,074
               
               
                  0802
                  Reimbursable program (Federal sources)
                  43
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,941
                  2,009
                  2,074
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  4,560
                  4,739
                  4,819
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  973
                  947
                  948
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  973
                  947
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  989
                  947
                  948
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,622
                  2,730
                  2,743
               
               
                  1120
                  Appropriations transferred to other accts [075â0128]
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,620
                  2,728
                  2,743
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  2
                  2
                  2
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,958
                  2,010
                  2,075
               
               
                  1700
                  Collected
                  
                  59
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  27
                  â59
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  533
                  567
                  333
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â630
                  â567
                  â333
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,888
                  2,010
                  2,075
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  8
                  
                  
               
               
                  1900
                  Budget authority (total)
                  4,518
                  4,740
                  4,820
               
               
                  1930
                  Total budgetary resources available
                  5,507
                  5,687
                  5,768
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  947
                  948
                  949
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2,677
                  2,781
                  2,988
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4,560
                  4,739
                  4,819
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â4,373
                  â4,532
                  â4,683
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â16
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â69
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,781
                  2,988
                  3,124
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â51
                  â59
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â27
                  59
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â59
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2,626
                  2,722
                  2,988
               
               
                  3200
                  Obligated balance, end of year
                  2,722
                  2,988
                  3,124
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,508
                  4,738
                  4,818
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,062
                  3,602
                  3,676
               
               
                  4011
                  Outlays from discretionary balances
                  2,297
                  928
                  1,005
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,359
                  4,530
                  4,681
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â31
                  â59
                  
               
               
                  4033
                  Non-Federal sources
                  â1,942
                  â2,010
                  â2,075
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,973
                  â2,069
                  â2,075
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â27
                  59
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â12
                  59
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  2,523
                  2,728
                  2,743
               
               
                  4080
                  Outlays, net (discretionary)
                  2,386
                  2,461
                  2,606
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  10
                  2
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  2
                  2
               
               
                  4101
                  Outlays from mandatory balances
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  14
                  2
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  2
                  2
                  2
               
               
                  4170
                  Outlays, net (mandatory)
                  6
                  2
                  2
               
               
                  4180
                  Budget authority, net (total)
                  2,525
                  2,730
                  2,745
               
               
                  4190
                  Outlays, net (total)
                  2,392
                  2,463
                  2,608
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  541
                  638
                  638
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  638
                  638
                  638
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,525
                  2,730
                  2,745
               
               
                  
                  Outlays
                  2,392
                  2,463
                  2,608
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  75
               
               
                  
                  Outlays
                  
                  
                  15
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,525
                  2,730
                  2,820
               
               
                  
                  Outlays
                  2,392
                  2,463
                  2,623
               
               
                  
                     
                  
               
            
         
      
      
         [In millions of dollars]
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2015
                     2016
                     2017
                  
                  
                     
                        
                     
                  
                  
                     Distribution of discretionary budget authority by account:
                     
                     
                     
                  
                  
                     Salaries and expenses
                     2,587
                     2,719
                     2,731
                  
                  
                     Buildings and facilities
                     9
                     9
                     12
                  
                  
                     Distribution of discretionary outlays by account:
                     
                     
                     
                  
                  
                     Salaries and expenses
                     2,376
                     2,512
                     2,599
                  
                  
                     Buildings and facilities
                     10
                     8
                     7
                  
                  
                     
                        
                     
                  
               
            
         
         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 responsibility 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 2017 Budget provides funding to support food and medical
            product safety, including implementation of the Food Safety Modernization Act , encourages development of innovative diagnostics
            and therapeutics, including cancer diagnostics and treatments, and improves the integrity of operations and infrastructure.
            
         
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  864
                  896
                  909
               
               
                  11.3
                  Other than full-time permanent
                  89
                  92
                  94
               
               
                  11.5
                  Other personnel compensation
                  37
                  39
                  40
               
               
                  11.7
                  Military personnel
                  63
                  63
                  64
               
               
                  11.8
                  Special personal services payments
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,054
                  1,091
                  1,108
               
               
                  12.1
                  Civilian personnel benefits
                  318
                  329
                  335
               
               
                  12.2
                  Military personnel benefits
                  31
                  32
                  32
               
               
                  21.0
                  Travel and transportation of persons
                  47
                  50
                  50
               
               
                  22.0
                  Transportation of things
                  4
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  169
                  177
                  170
               
               
                  23.2
                  Rental payments to others
                  5
                  6
                  6
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  31
                  33
                  33
               
               
                  24.0
                  Printing and reproduction
                  2
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  69
                  70
                  70
               
               
                  25.2
                  Other services from non-Federal sources
                  345
                  365
                  364
               
               
                  25.3
                  Other goods and services from Federal sources
                  126
                  131
                  131
               
               
                  25.4
                  Operation and maintenance of facilities
                  81
                  86
                  86
               
               
                  25.5
                  Research and development contracts
                  17
                  16
                  16
               
               
                  25.7
                  Operation and maintenance of equipment
                  76
                  81
                  81
               
               
                  26.0
                  Supplies and materials
                  46
                  48
                  48
               
               
                  31.0
                  Equipment
                  71
                  75
                  75
               
               
                  32.0
                  Land and structures
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  125
                  132
                  132
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,619
                  2,730
                  2,745
               
               
                  99.0
                  Reimbursable obligations
                  1,941
                  2,009
                  2,074
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  4,560
                  4,739
                  4,819
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  9,435
                  9,687
                  9,715
               
               
                  1101
                  Direct military average strength employment
                  696
                  696
                  696
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  5,052
                  5,520
                  5,629
               
               
                  2101
                  Reimbursable military average strength employment
                  373
                  373
                  373
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  27
                  27
                  27
               
               
                  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 075â9911â2â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Food Facility Registration and Inspection
                  
                  
                  61
               
               
                  0802
                  Food Import
                  
                  
                  105
               
               
                  0803
                  International Courier
                  
                  
                  6
               
               
                  0804
                  Food Contact Substance Notification
                  
                  
                  5
               
               
                  0805
                  Cosmetics
                  
                  
                  20
               
               
                  0806
                  Export Certification Fee Increase
                  
                  
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  201
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  201
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  
                  201
               
               
                  1900
                  Budget authority (total)
                  
                  
                  201
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  201
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  201
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â201
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  201
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  201
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â201
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â201
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The FY 2017 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 $105 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
            $61 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 proposes 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 075â9911â2â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  
                  29
               
               
                  11.3
                  Other than full-time permanent
                  
                  
                  4
               
               
                  11.5
                  Other personnel compensation
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  36
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  20
               
               
                  21.0
                  Travel and transportation of persons
                  
                  
                  2
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  6
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  10
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  61
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  35
               
               
                  25.4
                  Operation and maintenance of facilities
                  
                  
                  3
               
               
                  25.5
                  Research and development contracts
                  
                  
                  2
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  4
               
               
                  26.0
                  Supplies and materials
                  
                  
                  2
               
               
                  31.0
                  Equipment
                  
                  
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  201
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  201
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  242
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses                                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â4â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0014
                  Cancer Initiative
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  15
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from other acct [075â9915]
                  
                  
                  75
               
               
                  1900
                  Budget authority (total)
                  
                  
                  75
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  75
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  60
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  15
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â15
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  75
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  15
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  75
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  15
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â4â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  
                  
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  7
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  2
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  15
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â4â1â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  51
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other Services                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Revolving Fund for Certification and Other Services (Reimbursable)
                  7
                  9
                  10
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  5
                  5
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  7
                  9
                  9
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  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)
                  7
                  9
                  10
               
               
                  1900
                  Budget authority (total)
                  7
                  9
                  10
               
               
                  1930
                  Total budgetary resources available
                  12
                  14
                  15
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  5
                  5
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  1
                  1
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7
                  9
                  10
               
               
                  3020
                  Outlays (gross)
                  â8
                  â9
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  1
                  1
               
               
                  3200
                  Obligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  7
                  9
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  9
                  10
               
               
                  4101
                  Outlays from mandatory balances
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  8
                  9
                  10
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â7
                  â9
                  â9
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  1
               
               
                  4190
                  Outlays, net (total)
                  1
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  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 . These services are financed wholly by fees paid by the industries affected.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  3
                  5
                  5
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  2
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  7
                  9
                  10
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  36
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services Administration                                                                             
            
         Federal Funds
         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, [$1,491,522,000 (in addition to the $3,600,000,000 previously appropriated to the Community Health Center Fund for fiscal year
         2016)] $1,342,422,000: Provided, That no more than [$100,000] $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,893,000  shall be available until expended for carrying out the provisions of Public Law 104â73 and for expenses incurred by the Department
         of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative claims made under such law [: 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 2016, not less than $200,000,000 shall be obligated in fiscal year 2016 to support new access points,
         grants to expand medical services, behavioral health, oral health, pharmacy, or vision services, and not less than $150,000,000
         shall be obligated in fiscal year 2016 for construction and capital improvement costs: Provided further, That the time limitation in section 330(e)(3) of the PHS Act shall not apply in fiscal year 2016]. 
         Health workforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, [$786,895,000] $536,745,000: Provided, That $20,000,000, 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 of Health and
         Human Services (referred to in this title as 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 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. 
         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, $845,117,000: 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 subparagraphs (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, [$2,322,781,000] $2,297,781,000,  of which $1,970,881,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through September 30, [2018] 2019, for parts A and B of title XXVI of the PHS Act, and of which not less than $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, $34,000,000 shall be available under section 241 of the PHS Act to
            carry out section 2691 of such Act, notwithstanding subsection (a) of such 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] $110,193,000, of which $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, and sections 711 and 1820 of the Social Security Act, [$149,571,000] $144,162,000, of which [$41,609,000] $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 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 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] $300,000,000: 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 ("HRSA"), [$154,000,000] $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 discretionary funds (pursuant to the Balanced Budget and Emergency
            Deficit Control Act of 1985) which are appropriated for the current fiscal year for HRSA in this Act 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0009
                  Free Clinics Medical Malpractice
                  1
                  
                  1
               
               
                  0010
                  Health Centers
                  1,392
                  1,392
                  1,242
               
               
                  0012
                  National Health Service Corps
                  
                  
                  20
               
               
                  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
                  NURSE Corps Scholarship and Loan Repayment Program
                  82
                  83
                  83
               
               
                  0017
                  Health Workforce
                  402
                  407
                  433
               
               
                  0018
                  Maternal and Child Health Block Grant
                  637
                  638
                  638
               
               
                  0019
                  Healthy Start
                  102
                  104
                  104
               
               
                  0020
                  Poison Control Centers
                  19
                  19
                  19
               
               
                  0021
                  Emergency Medical Services for Children
                  20
                  20
                  20
               
               
                  0022
                  James T.Walsh Universal Newborn Hearing Screening
                  18
                  18
                  18
               
               
                  0023
                  HIV/AIDS
                  2,318
                  2,323
                  2,298
               
               
                  0024
                  Organ Transplantation
                  24
                  24
                  24
               
               
                  0025
                  C.W. Bill Young Cell Transplantation Program
                  22
                  22
                  22
               
               
                  0026
                  Rural Health Policy Development
                  9
                  9
                  9
               
               
                  0027
                  Rural Health Outreach Grants
                  59
                  64
                  64
               
               
                  0028
                  Rural Hospital Flexibility Grants
                  42
                  42
                  26
               
               
                  0030
                  Telehealth
                  15
                  17
                  17
               
               
                  0031
                  Program Management
                  154
                  154
                  157
               
               
                  0032
                  Family Planning
                  286
                  286
                  300
               
               
                  0033
                  Loan Repayment/Faculty Fellowships
                  1
                  1
                  1
               
               
                  0035
                  Health Centers Tort Claims
                  102
                  100
                  100
               
               
                  0036
                  Heritable Disorders
                  14
                  14
                  14
               
               
                  0038
                  Children's Hospital Graduate Medical Education
                  265
                  295
                  
               
               
                  0041
                  State Offices of Rural Health
                  10
                  10
                  10
               
               
                  0043
                  Radiation Exposure Screening and Education Program
                  2
                  2
                  2
               
               
                  0044
                  Traumatic Brain Injury
                  9
                  
                  
               
               
                  0045
                  Autism and Other Developmental Disorders
                  47
                  47
                  47
               
               
                  0046
                  National Cord Blood Inventory
                  11
                  11
                  11
               
               
                  0048
                  Sickle Cell Service Demonstrations
                  4
                  4
                  4
               
               
                  0049
                  340 B Drug Pricing Program/Office of Pharmacy Affairs
                  10
                  10
                  17
               
               
                  0050
                  Family to Family Health Information Centers ACA
                  5
                  5
                  5
               
               
                  0073
                  Health Centers ACA
                  3,309
                  3,695
                  3,695
               
               
                  0075
                  National Health Service Corps ACA
                  290
                  324
                  310
               
               
                  0076
                  School Based Health Centers ACA
                  1
                  
                  
               
               
                  0077
                  GME Payments THC ACA
                  121
                  60
                  60
               
               
                  0079
                  Rural & Community Access to Emergency Devices
                  5
                  
                  
               
               
                  0080
                  Prevention Fund
                  57
                  
                  
               
               
                  0082
                  Rural Opioid Overdose Reversal Grant Program
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  9,889
                  10,224
                  9,805
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  9,889
                  10,224
                  9,805
               
               
                  0801
                  Health Resources and Services (Reimbursable)
                  48
                  48
                  61
               
               
                  0802
                  Reimbursable program: PHS evaluation
                  
                  
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  48
                  48
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  9,937
                  10,272
                  9,900
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  298
                  407
                  296
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  146
                  139
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  70
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  393
                  407
                  296
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  6,105
                  6,140
                  5,733
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3,915
                  3,975
                  3,975
               
               
                  1220
                  Appropriations transferred to other acct [015â5606]
                  
                  â5
                  â5
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â114
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  3,801
                  3,970
                  3,970
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  25
                  35
                  75
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  34
                  35
                  75
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Offsetting collections (cash)(HPSL&NSL)
                  20
                  16
                  16
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  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)
                  20
                  16
                  17
               
               
                  1900
                  Budget authority (total)
                  9,960
                  10,161
                  9,795
               
               
                  1930
                  Total budgetary resources available
                  10,353
                  10,568
                  10,091
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â9
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  407
                  296
                  191
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,232
                  7,398
                  7,995
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  9,937
                  10,272
                  9,900
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â8,607
                  â9,675
                  â10,744
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â25
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â140
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,398
                  7,995
                  7,151
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â66
                  â36
                  â36
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â36
                  â36
                  â36
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,166
                  7,362
                  7,959
               
               
                  3200
                  Obligated balance, end of year
                  7,362
                  7,959
                  7,115
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  6,139
                  6,175
                  5,808
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,902
                  2,323
                  2,176
               
               
                  4011
                  Outlays from discretionary balances
                  3,731
                  3,995
                  3,792
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  5,633
                  6,318
                  5,968
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â45
                  â13
                  â44
               
               
                  4033
                  Non-Federal sources
                  â21
                  â22
                  â22
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â66
                  â35
                  â75
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  6,105
                  6,140
                  5,733
               
               
                  4080
                  Outlays, net (discretionary)
                  5,567
                  6,283
                  5,893
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  3,821
                  3,986
                  3,987
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,464
                  1,927
                  1,964
               
               
                  4101
                  Outlays from mandatory balances
                  1,510
                  1,430
                  2,812
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,974
                  3,357
                  4,776
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â20
                  â16
                  â16
               
               
                  4180
                  Budget authority, net (total)
                  9,906
                  10,110
                  9,704
               
               
                  4190
                  Outlays, net (total)
                  8,521
                  9,624
                  10,653
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  9,906
                  10,110
                  9,704
               
               
                  
                  Outlays
                  8,521
                  9,624
                  10,653
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  495
               
               
                  
                  Outlays
                  
                  
                  219
               
               
                  Total:
               
               
                  
                  Budget Authority
                  9,906
                  10,110
                  10,199
               
               
                  
                  Outlays
                  8,521
                  9,624
                  10,872
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Guaranteed loan levels supportable by subsidy budget authority:
               
               
                  215001
                  Health centers: Facilities renovation loan guarantee levels
                  
                  9
                  4
               
               
                  215002
                  Health centers: Managed care network development loan guarantee
                  
                  
                  1
               
               
                  215003
                  Health centers: Managed care plan loan guarantee levels
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  215999
                  Total loan guarantee levels
                  
                  9
                  6
               
               
                  
                  Guaranteed loan subsidy (in percent):
               
               
                  232001
                  Health centers: Facilities renovation loan guarantee levels
                  2.67
                  2.67
                  2.65
               
               
                  232002
                  Health centers: Managed care network development loan guarantee
                  0.00
                  0.00
                  9.48
               
               
                  232003
                  Health centers: Managed care plan loan guarantee levels
                  0.00
                  0.00
                  5.69
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  232999
                  Weighted average subsidy rate
                  0.00
                  2.67
                  4.30
               
               
                  
                     
                  
               
            
         
      
      
         Resources displayed here support categorical grants and contracts managed by Health Resources and Services Administration
            (HRSA). These activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce
            training, maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, 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 2017 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 2014â2015 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     405,831,597
                  
                  
                     NSL
                     182,345,335
                  
                  
                     PCL
                     251,721,912
                  
                  
                     LDS
                     149,818,689
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     989,717,533
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  163
                  191
                  191
               
               
                  11.3
                  Other than full-time permanent
                  7
                  7
                  7
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  18
                  19
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  191
                  220
                  220
               
               
                  12.1
                  Civilian personnel benefits
                  52
                  61
                  61
               
               
                  12.2
                  Military personnel benefits
                  10
                  10
                  10
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  23
                  23
                  23
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  6
                  6
                  6
               
               
                  25.1
                  Advisory and assistance services
                  11
                  10
                  10
               
               
                  25.2
                  Other services from non-Federal sources
                  180
                  179
                  181
               
               
                  25.3
                  Other goods and services from Federal sources
                  288
                  274
                  266
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.6
                  Medical care
                  3
                  3
                  3
               
               
                  25.7
                  Operation and maintenance of equipment
                  11
                  11
                  10
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  22
                  22
                  19
               
               
                  41.0
                  Grants, subsidies, and contributions
                  8,992
                  9,309
                  8,900
               
               
                  42.0
                  Insurance claims and indemnities
                  94
                  90
                  90
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  9,889
                  10,224
                  9,805
               
               
                  99.0
                  Reimbursable obligations
                  48
                  48
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  9,937
                  10,272
                  9,900
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,576
                  1,800
                  1,780
               
               
                  1101
                  Direct military average strength employment
                  184
                  184
                  183
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  51
                  60
                  69
               
               
                  2101
                  Reimbursable military average strength employment
                  3
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0012
                  National Health Service Corps
                  
                  
                  50
               
               
                  0073
                  Health Centers
                  
                  
                  150
               
               
                  0081
                  Children's Hospital Graduate Medical Education
                  
                  
                  295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total direct programs
                  
                  
                  495
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  495
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  495
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  495
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  495
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â219
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  276
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  276
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  495
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  219
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  495
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  219
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  52
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  7
               
               
                  31.0
                  Equipment
                  
                  
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  431
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  495
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  21
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  1
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury Compensation                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0320â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  23
                  28
                  28
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  5
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  28
                  28
                  28
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  28
                  28
                  28
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5
                  
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â5
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â5
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0343â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Claims
                  4
                  1
                  1
               
               
                  0103
                  Admin Expense
                  
                  3
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  4
                  4
                  3
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  3
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  4
                  1
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7
                  4
                  3
               
               
                  1930
                  Total budgetary resources available
                  7
                  4
                  3
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  2
                  1
                  1
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4
                  4
                  3
               
               
                  3020
                  Outlays (gross)
                  â5
                  â4
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  1
                  1
               
               
                  3200
                  Obligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  5
                  4
                  3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  5
                  4
                  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 PHS Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox
            Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  42.0
                  Insurance claims and indemnities
                  2
                  2
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4
                  4
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  4
                  4
                  3
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  7
                  7
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0010
                  Maternal, Infant, and Early Childhood Home Visiting Programs
                  430
                  413
                  403
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  27
                  16
                  3
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  2
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  46
                  16
                  3
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  400
                  400
                  400
               
               
                  1930
                  Total budgetary resources available
                  446
                  416
                  403
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  16
                  3
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  703
                  750
                  770
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  430
                  413
                  403
               
               
                  3020
                  Outlays (gross)
                  â364
                  â393
                  â395
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â17
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  750
                  770
                  778
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  703
                  750
                  770
               
               
                  3200
                  Obligated balance, end of year
                  750
                  770
                  778
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  400
                  400
                  400
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  12
                  16
                  16
               
               
                  4101
                  Outlays from mandatory balances
                  352
                  377
                  379
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  364
                  393
                  395
               
               
                  4180
                  Budget authority, net (total)
                  400
                  400
                  400
               
               
                  4190
                  Outlays, net (total)
                  364
                  393
                  395
               
               
                  
                     
                  
               
            
         
      
      
          Public Law 114â10 provides resources to Maternal, Infant and Early Childhood Home Visiting Program through FY 2017 to provide
            comprehensive services for at risk communities.  These activities are administered by HRSA.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  2
                  3
                  3
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  3
                  4
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  20
                  20
                  20
               
               
                  41.0
                  Grants, subsidies, and contributions
                  406
                  388
                  378
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  430
                  413
                  403
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  20
                  24
                  24
               
               
                  1101
                  Direct military average strength employment
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing Account                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  2015 actual
                  2016 est.
                  2017 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
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on commitments:
               
               
                  2121
                  Limitation available from carry-forward
                  15
                  15
                  6
               
               
                  2143
                  Uncommitted limitation carried forward
                  â15
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2150
                  Total guaranteed loan commitments
                  
                  9
                  6
               
               
                  2199
                  Guaranteed amount of guaranteed loan commitments
                  
                  7
                  5
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of guaranteed loans outstanding:
               
               
                  2210
                  Outstanding, start of year
                  80
                  76
                  73
               
               
                  2231
                  Disbursements of new guaranteed loans
                  
                  8
                  6
               
               
                  2251
                  Repayments and prepayments
                  â4
                  â10
                  â10
               
               
                  2263
                  Adjustments: Terminations for default that result in claim payments
                  
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2290
                  Outstanding, end of year
                  76
                  73
                  68
               
               
                  
                     
                  
               
               
                  
                  Memorandum:
               
               
                  2299
                  Guaranteed amount of guaranteed loans outstanding, end of year
                  75
                  73
                  68
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 104â299 and Public Law 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. 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 075â4442â0â3â551
                  2014 actual
                  2015 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
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan Fund                                                                               
            
         Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  6
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
      
         Titles VI and XVI of the PHS 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 the
            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 075â9931â0â3â551
                  2014 actual
                  2015 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1601
                  Direct loans, gross
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  6
                  6
               
               
                  
                  LIABILITIES:
               
               
                  2201
                  Non-Federal liabilities: Accounts payable
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
      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 [$7,500,000] $9,200,000 shall be available from the Trust Fund to the Secretary. (Department of Health and Human Services Appropriations Act, 2016.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  3,356
                  3,452
                  3,586
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Deposits, Vaccine Injury Compensation Trust Fund
                  275
                  311
                  318
               
               
                  1140
                  Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                  62
                  83
                  117
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  337
                  394
                  435
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  337
                  394
                  435
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  3,693
                  3,846
                  4,021
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â18
                  â23
                  â27
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â221
                  â237
                  â240
               
               
                  2102
                  Vaccine Injury Compensation Program Trust Fund
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â241
                  â260
                  â267
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â241
                  â260
                  â267
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  3,452
                  3,586
                  3,754
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Compensation: Claims for post - FY 1989 injuries
                  229
                  237
                  240
               
               
                  0103
                  Claims processing (Claims Court)
                  5
                  6
                  6
               
               
                  0104
                  Claims processing (HRSA)
                  8
                  8
                  9
               
               
                  0105
                  Claims processing (Dept. of Justice)
                  5
                  9
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total, administrative expenses
                  18
                  23
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  247
                  260
                  267
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  3
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  18
                  23
                  27
               
               
                  1102
                  Appropriation (previously unavailable)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  20
                  23
                  27
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  221
                  237
                  240
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  3
                  
                  
               
               
                  1900
                  Budget authority (total)
                  244
                  260
                  267
               
               
                  1930
                  Total budgetary resources available
                  247
                  260
                  267
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  11
                  15
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  247
                  260
                  267
               
               
                  3020
                  Outlays (gross)
                  â240
                  â275
                  â267
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  15
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  11
                  15
                  
               
               
                  3200
                  Obligated balance, end of year
                  15
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  20
                  23
                  27
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  14
                  23
                  27
               
               
                  4011
                  Outlays from discretionary balances
                  2
                  15
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  16
                  38
                  27
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  224
                  237
                  240
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  224
                  237
                  240
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â3
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  241
                  260
                  267
               
               
                  4190
                  Outlays, net (total)
                  237
                  275
                  267
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  3,360
                  3,453
                  3,615
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  3,453
                  3,615
                  3,810
               
               
                  
                     
                  
               
            
         
      
      
         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. 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 075â8175â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  3
                  3
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  4
                  6
               
               
                  42.0
                  Insurance claims and indemnities
                  240
                  252
                  257
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  247
                  260
                  267
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  16
                  23
                  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, [$3,566,387,000] $3,815,109,000, 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, [$914,139,000] $962,331,000 for Purchased/Referred Care, including [$51,500,000] $53,000,000 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, of the funds provided, [$2,000,000] $11,000,000 shall [be used] remain available until expended to supplement funds available for operational costs at tribal clinics operated under an Indian Self-Determination and Education
         Assistance Act compact or contract where health care is delivered in space acquired through a full service lease, which is
         not eligible for maintenance and improvement and equipment funds from the Indian Health Service [, and $2,000,000 shall be for accreditation emergencies]: 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] Substance Abuse and Suicide Prevention Program, for the [domestic violence prevention initiative] Domestic Violence Prevention Program, for the Zero Suicide Initiative, for aftercare pilots at Youth Regional Treatment Centers, to improve collections from public and private insurance at Indian Health Service and tribally operated facilities, and for
         accreditation emergencies 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Clinical services
                  3,197
                  3,241
                  3,474
               
               
                  0002
                  Preventive health
                  154
                  156
                  166
               
               
                  0003
                  Urban health
                  44
                  45
                  48
               
               
                  0004
                  Indian health professions
                  48
                  48
                  49
               
               
                  0005
                  Tribal management
                  2
                  2
                  2
               
               
                  0006
                  Direct operations
                  68
                  68
                  70
               
               
                  0007
                  Self-governance
                  6
                  6
                  6
               
               
                  0008
                  Contract support costs
                  663
                  
                  
               
               
                  0009
                  Diabetes funds
                  150
                  150
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,332
                  3,716
                  3,965
               
               
                  0801
                  Indian Health Services (Reimbursable)
                  1,335
                  1,194
                  1,194
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  5,667
                  4,910
                  5,159
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  668
                  740
                  968
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  63
                  63
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  99
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  767
                  740
                  968
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  4,182
                  3,566
                  3,815
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  150
                  150
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,371
                  1,422
                  1,422
               
               
                  1900
                  Budget authority (total)
                  5,703
                  5,138
                  5,387
               
               
                  1930
                  Total budgetary resources available
                  6,470
                  5,878
                  6,355
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â63
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  740
                  968
                  1,196
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  807
                  917
                  578
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  5,667
                  4,910
                  5,159
               
               
                  3011
                  Obligations incurred, expired accounts
                  36
                  40
                  
               
               
                  3020
                  Outlays (gross)
                  â5,472
                  â5,269
                  â5,345
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â99
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  â20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  917
                  578
                  392
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â68
                  â67
                  â67
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â67
                  â67
                  â67
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  739
                  850
                  511
               
               
                  3200
                  Obligated balance, end of year
                  850
                  511
                  325
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  5,553
                  4,988
                  5,237
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,570
                  4,346
                  4,551
               
               
                  4011
                  Outlays from discretionary balances
                  755
                  773
                  644
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  5,325
                  5,119
                  5,195
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â243
                  â271
                  â271
               
               
                  4033
                  Non-Federal sources
                  â1,130
                  â1,151
                  â1,151
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,373
                  â1,422
                  â1,422
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  4,182
                  3,566
                  3,815
               
               
                  4080
                  Outlays, net (discretionary)
                  3,952
                  3,697
                  3,773
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  150
                  150
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  47
                  144
                  144
               
               
                  4101
                  Outlays from mandatory balances
                  100
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  147
                  150
                  150
               
               
                  4180
                  Budget authority, net (total)
                  4,332
                  3,716
                  3,965
               
               
                  4190
                  Outlays, net (total)
                  4,099
                  3,847
                  3,923
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,332
                  3,716
                  3,965
               
               
                  
                  Outlays
                  4,099
                  3,847
                  3,923
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  25
               
               
                  
                  Outlays
                  
                  
                  12
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,332
                  3,716
                  3,990
               
               
                  
                  Outlays
                  4,099
                  3,847
                  3,935
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Services account provides medical care, public health services, and health professions training opportunities
            to American Indians and Alaska Natives. More than $2 .7 billion, primarily through self-determination contracts and compacts,
            will be administered by tribal governments in 2017.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  389
                  393
                  400
               
               
                  11.3
                  Other than full-time permanent
                  18
                  18
                  18
               
               
                  11.5
                  Other personnel compensation
                  56
                  57
                  58
               
               
                  11.7
                  Military personnel
                  71
                  72
                  73
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  534
                  540
                  549
               
               
                  12.1
                  Civilian personnel benefits
                  148
                  150
                  153
               
               
                  12.2
                  Military personnel benefits
                  32
                  32
                  33
               
               
                  13.0
                  Benefits for former personnel
                  12
                  12
                  12
               
               
                  21.0
                  Patient travel
                  44
                  46
                  48
               
               
                  22.0
                  Transportation of things
                  6
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  15
                  16
                  17
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  10
                  10
                  11
               
               
                  25.1
                  Advisory and assistance services
                  5
                  5
                  5
               
               
                  25.2
                  Other services from non-Federal sources
                  95
                  101
                  130
               
               
                  25.3
                  Other goods and services from Federal sources
                  72
                  76
                  79
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  6
                  6
               
               
                  25.6
                  Medical care
                  324
                  339
                  355
               
               
                  25.7
                  Operation and maintenance of equipment
                  11
                  13
                  12
               
               
                  25.8
                  Subsistence and support of persons
                  5
                  4
                  5
               
               
                  26.0
                  Supplies and materials
                  100
                  107
                  113
               
               
                  31.0
                  Equipment
                  12
                  13
                  14
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,876
                  2,211
                  2,387
               
               
                  42.0
                  Insurance claims and indemnities
                  28
                  28
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,332
                  3,716
                  3,965
               
               
                  99.0
                  Reimbursable obligations
                  1,335
                  1,194
                  1,194
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  5,667
                  4,910
                  5,159
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6,506
                  6,520
                  6,541
               
               
                  1101
                  Direct military average strength employment
                  989
                  991
                  986
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  5,469
                  5,469
                  5,476
               
               
                  2101
                  Reimbursable military average strength employment
                  832
                  832
                  825
               
               
                  
                     
                  
               
            
         
      
         Indian Health Services                                                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Clinical services
                  
                  
                  15
               
               
                  0004
                  Indian health professions
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  25
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  25
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  25
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  13
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  13
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  12
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  25
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  12
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  25
               
               
                  
                     
                  
               
            
         
      
         Contract support costsFor payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education
         Assistance Act agreements with the Indian Health Service for fiscal year [2016] 2017, such sums as may be necessary: Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements
         for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal
         years: Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
         to another budget account. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contract Support Costs
                  
                  718
                  800
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.3)
                  
                  718
                  800
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  718
                  800
               
               
                  1930
                  Total budgetary resources available
                  
                  718
                  800
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  718
                  800
               
               
                  3020
                  Outlays (gross)
                  
                  â718
                  â800
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  718
                  800
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  718
                  800
               
               
                  4180
                  Budget authority, net (total)
                  
                  718
                  800
               
               
                  4190
                  Outlays, net (total)
                  
                  718
                  800
               
               
                  
                     
                  
               
            
         
      
      
         The Contract Support Costs account provides for the reasonable and allowable costs for direct program expenses for the operation
            of, and any additional administrative or other expense related to, the overhead incurred by tribes and tribal organizations
            who operate health programs through self-determination contracts and compacts. An estimated $800 million in contract support
            costs funds will be provided to tribal governments and tribal organizations in 2017. 
         
      
         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, [$523,232,000] $569,906,000, 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, 2016.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Rent and Charges for Quarters, Indian Health Service
                  7
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  7
                  8
                  8
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Indian Health Facilities
                  â7
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Sanitation and health facilities
                  114
                  204
                  235
               
               
                  0002
                  Maintenance
                  54
                  74
                  77
               
               
                  0003
                  Facilities and environmental health
                  207
                  222
                  234
               
               
                  0004
                  Equipment
                  23
                  23
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  398
                  523
                  570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  398
                  523
                  570
               
               
                  0801
                  Indian Health Facilities (Reimbursable)
                  9
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  407
                  532
                  579
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  171
                  236
                  290
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  165
                  165
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  176
                  236
                  290
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  460
                  523
                  570
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  7
                  8
                  8
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  
                  55
                  56
               
               
                  1900
                  Budget authority (total)
                  467
                  586
                  634
               
               
                  1930
                  Total budgetary resources available
                  643
                  822
                  924
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  236
                  290
                  345
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  504
                  453
                  421
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  407
                  532
                  579
               
               
                  3020
                  Outlays (gross)
                  â451
                  â564
                  â581
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  453
                  421
                  419
               
               
                  
                  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
                  499
                  448
                  416
               
               
                  3200
                  Obligated balance, end of year
                  448
                  416
                  414
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  460
                  578
                  626
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  243
                  212
                  227
               
               
                  4011
                  Outlays from discretionary balances
                  199
                  344
                  346
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  442
                  556
                  573
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  
                  â55
                  â56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  â55
                  â56
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  7
                  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)
                  467
                  531
                  578
               
               
                  4190
                  Outlays, net (total)
                  451
                  509
                  525
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
            facilities support for the Indian Health Service. More than $368 million, primarily through self-determination contracts and
            compacts, will be administered by tribal governments in 2017.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  49
                  46
                  48
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  23
                  23
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  76
                  73
                  75
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  16
                  16
               
               
                  12.2
                  Military personnel benefits
                  8
                  8
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  3
                  3
               
               
                  22.0
                  Transportation of things
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  14
                  15
                  15
               
               
                  25.1
                  Advisory and assistance services
                  1
                  1
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  63
                  86
                  113
               
               
                  25.3
                  Other goods and services from Federal sources
                  3
                  3
                  3
               
               
                  25.4
                  Operation and maintenance of facilities
                  6
                  16
                  18
               
               
                  25.7
                  Operation and maintenance of equipment
                  3
                  13
                  14
               
               
                  25.8
                  Subsistence and support of persons
                  2
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  6
                  7
                  7
               
               
                  31.0
                  Equipment
                  14
                  23
                  24
               
               
                  32.0
                  Land and structures
                  32
                  89
                  93
               
               
                  41.0
                  Grants, subsidies, and contributions
                  148
                  164
                  172
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  398
                  523
                  570
               
               
                  99.0
                  Reimbursable obligations
                  9
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  407
                  532
                  579
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,104
                  1,106
                  1,094
               
               
                  1101
                  Direct military average strength employment
                  171
                  169
                  181
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  32
                  32
                  32
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONSâINDIAN HEALTH SERVICE                                                                          
            
         
         Administrative provisionsâindian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
         3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
         5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
         and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
         in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
         5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
         Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
         care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
         recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
         providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
         to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
         Law 93â638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
         purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
         by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
         [approved by] 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: Provided further, That the Indian Health Service shall develop a strategic plan for the Urban Indian Health program in consultation with urban
         Indians and the National Academy of Public Administration, and shall publish such plan not later than one year after the date
         of enactment of this Act]. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2016.)
         Centers for Disease Control and Prevention                                                                               
            
         Federal Funds
         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, [$459,055,000] $411,716,000. 
         HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis preventionFor carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
         diseases, and tuberculosis prevention, [$1,122,278,000] $1,127,278,000. 
         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, [$527,885,000] $577,485,000: Provided, That of the 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, [$838,146,000] $679,745,000: Provided, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for not
         less than 21 States, tribes, or tribal organizations: [Provided further, That of the funds available under this heading, $10,000,000 shall be available to continue and expand community specific
         extension and outreach programs to combat obesity in counties with the highest levels of obesity:] Provided further, That 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, [$135,610,000] $67,644,000. 
         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, [$491,597,000] $464,355,000. 
         Environmental healthFor carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, [$165,303,000] $167,825,000. 
         Injury prevention and controlFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, [$236,059,000: Provided, That of the funds provided under this heading, $70,000,000 shall be available for an evidence-based opioid drug overdose
         prevention program] $268,629,000. 
         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 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, [$339,121,000] $213,621,000: Provided, That in addition to the amounts provided herein, $72,000,000 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, [$427,121,000] $442,121,000, of which [$128,421,000] $128,421,000 for international HIV/AIDS shall remain available through September 30, [2017] 2018: 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, [$1,405,000,000] $1,402,166,000, of which [$575,000,000] $575,000,000 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 Centers for Disease Control and Prevention ("CDC") or the Administrator of the Agency for Toxic Substances and Disease Registry may detail [CDC] staff without reimbursement for up to [90] 180 days to support [the work] an activation 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 funds appropriated under this heading may be used to support a contract for the operation and maintenance of an aircraft
         in direct support of activities throughout CDC to ensure the agency is prepared to address public health preparedness emergencies]. 
         cdc-wide activities and program supportFor carrying out titles II, III, XVII and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program
         support for activities funded in other appropriations included in this Act for the Centers for Disease Control and Prevention,
         $113,570,000: 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 and the Respirator Certification
         Program shall be available through September 30, [2017] 2018: Provided further, That of the funds made available under this heading and in all other accounts of CDC, up to $1,000
            per eligible employee of CDC shall be made available until expended for Individual Learning Accounts: Provided further, That
            the Director may transfer discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
            which are appropriated for the current fiscal year for CDC in this Act between any of the accounts of CDC with notification
            to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account
            shall be decreased by more than 3 percent by any such transfer. (Department of Health and Human Services Appropriations Act, 2016.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Cooperative Research and Development Agreements, Centers for Disease Control
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  2
                  2
                  2
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  CDC-Wide Activities and Program Support
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Birth Defects, Developmental Disabilities, Disability and Health (0958)
                  131
                  136
                  136
               
               
                  0002
                  CDC Wide Activities and Program Support (0943)
                  478
                  274
                  114
               
               
                  0004
                  Chronic Disease Prevention and Health Promotion (0948)
                  1,192
                  1,177
                  1,117
               
               
                  0005
                  Emerging and Zoonotics Infectious Diseases (0949)
                  405
                  580
                  629
               
               
                  0006
                  Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                  50
                  55
                  55
               
               
                  0007
                  Environmental Health (0947)
                  179
                  182
                  182
               
               
                  0008
                  Global Health (0955)
                  447
                  427
                  442
               
               
                  0012
                  HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                  1,118
                  1,122
                  1,127
               
               
                  0013
                  Immunization and Respiratory Diseases (0951)
                  798
                  799
                  748
               
               
                  0015
                  Injury Prevention and Control (0952)
                  170
                  236
                  269
               
               
                  0016
                  Occupational Safety and Health (0953)
                  334
                  339
                  286
               
               
                  0019
                  Public Health Preparedness and Response (0956)
                  1,352
                  1,405
                  1,402
               
               
                  0020
                  Public Health Scientific Services (0959)
                  481
                  492
                  501
               
               
                  0021
                  Cooperative Research and Development Agreements (CRADA) (5146)
                  4
                  2
                  2
               
               
                  0022
                  Ebola (Emergency pursuant to 2011 BCA)
                  526
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  7,665
                  7,226
                  7,010
               
               
                  0802
                  CDC-Wide Activities and Program Support (Reimbursable)
                  194
                  516
                  516
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  194
                  516
                  516
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  7,859
                  7,742
                  7,526
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  126
                  1,223
                  1,207
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  90
                  1,214
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â4553]
                  â2
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  15
                  
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  35
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  186
                  1,223
                  1,207
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  7,759
                  6,261
                  5,937
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  7,774
                  6,261
                  5,937
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  2
                  2
                  2
               
               
                  1221
                  Appropriations transferred from other acct [075â0116]
                  887
                  892
                  944
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  939
                  949
                  1,001
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  130
                  512
                  512
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  56
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  186
                  512
                  512
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  5
                  4
                  4
               
               
                  1900
                  Budget authority (total)
                  8,904
                  7,726
                  7,454
               
               
                  1930
                  Total budgetary resources available
                  9,090
                  8,949
                  8,661
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â8
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,223
                  1,207
                  1,135
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,822
                  6,501
                  7,009
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7,859
                  7,742
                  7,526
               
               
                  3011
                  Obligations incurred, expired accounts
                  31
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â7,016
                  â7,234
                  â7,982
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â183
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,501
                  7,009
                  6,553
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â215
                  â132
                  â132
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â56
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  139
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â132
                  â132
                  â132
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,607
                  6,369
                  6,877
               
               
                  3200
                  Obligated balance, end of year
                  6,369
                  6,877
                  6,421
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  7,960
                  6,773
                  6,449
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,778
                  3,012
                  2,876
               
               
                  4011
                  Outlays from discretionary balances
                  3,466
                  3,616
                  4,286
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  6,244
                  6,628
                  7,162
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â252
                  â512
                  â512
               
               
                  4033
                  Non-Federal sources
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â258
                  â512
                  â512
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â56
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  128
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  72
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  7,774
                  6,261
                  5,937
               
               
                  4080
                  Outlays, net (discretionary)
                  5,986
                  6,116
                  6,650
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  944
                  953
                  1,005
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  150
                  161
                  168
               
               
                  4101
                  Outlays from mandatory balances
                  622
                  445
                  652
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  772
                  606
                  820
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â5
                  â4
                  â4
               
               
                  4180
                  Budget authority, net (total)
                  8,713
                  7,210
                  6,938
               
               
                  4190
                  Outlays, net (total)
                  6,753
                  6,718
                  7,466
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  8,713
                  7,210
                  6,938
               
               
                  
                  Outlays
                  6,753
                  6,718
                  7,466
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  30
               
               
                  
                  Outlays
                  
                  
                  12
               
               
                  Total:
               
               
                  
                  Budget Authority
                  8,713
                  7,210
                  6,968
               
               
                  
                  Outlays
                  6,753
                  6,718
                  7,478
               
               
                  
                     
                  
               
            
         
      
      
         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. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  681
                  806
                  824
               
               
                  11.3
                  Other than full-time permanent
                  112
                  112
                  113
               
               
                  11.5
                  Other personnel compensation
                  39
                  38
                  38
               
               
                  11.7
                  Military personnel
                  77
                  75
                  77
               
               
                  11.8
                  Special personal services payments
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  916
                  1,038
                  1,059
               
               
                  12.1
                  Civilian personnel benefits
                  265
                  304
                  310
               
               
                  12.2
                  Military personnel benefits
                  52
                  51
                  52
               
               
                  13.0
                  Benefits for former personnel
                  
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  79
                  53
                  54
               
               
                  22.0
                  Transportation of things
                  13
                  12
                  12
               
               
                  23.1
                  Rental payments to GSA
                  6
                  33
                  34
               
               
                  23.2
                  Rental payments to others
                  2
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  26
                  52
                  53
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  826
                  763
                  655
               
               
                  25.2
                  Other services from non-Federal sources
                  234
                  297
                  227
               
               
                  25.3
                  Other goods and services from Federal sources
                  752
                  353
                  276
               
               
                  25.4
                  Operation and maintenance of facilities
                  16
                  40
                  24
               
               
                  25.5
                  Research and development contracts
                  47
                  50
                  39
               
               
                  25.6
                  Medical care
                  34
                  31
                  23
               
               
                  25.7
                  Operation and maintenance of equipment
                  39
                  74
                  56
               
               
                  25.8
                  Subsistence and support of persons
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  461
                  468
                  488
               
               
                  31.0
                  Equipment
                  67
                  70
                  83
               
               
                  32.0
                  Land and structures
                  2
                  7
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,823
                  3,523
                  3,557
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  7,665
                  7,226
                  7,010
               
               
                  99.0
                  Reimbursable obligations
                  194
                  516
                  516
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  7,859
                  7,742
                  7,526
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8,181
                  8,193
                  8,193
               
               
                  1101
                  Direct military average strength employment
                  850
                  850
                  850
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  257
                  257
                  257
               
               
                  2101
                  Reimbursable military average strength employment
                  43
                  43
                  43
               
               
                  
                     
                  
               
            
         
      
         CDC-Wide Activities and Program Support                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â4â1â999
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0024
                  Behavioral Health Init.
                  
                  
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  30
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (Health Behavioral Int.)
                  
                  
                  30
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  30
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  18
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  30
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  12
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  30
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  12
               
               
                  
                     
                  
               
            
         
      
         buildings and facilities
         (including transfer of funds)For [acquisition of real property,] equipment, construction, demolition, and renovation of facilities, [$10,000,000] $31,221,000, [which shall] to remain available until September 30, [2020 : Provided, That funds previously set-aside by CDC for repair and upgrade of the Lake Lynn Experimental Mine and Laboratory shall be
         used to acquire a replacement mine safety research facility: Provided further, That in addition, the prior year unobligated balance of any amounts assigned to former employees in accounts of CDC made
         available for Individual Learning Accounts shall be credited to and merged with the amounts made available under this heading
         to support the replacement of the mine safety research facility] 2021. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Buildings and Facilities (0960)
                  8
                  10
                  31
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  2
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  10
                  10
                  31
               
               
                  1930
                  Total budgetary resources available
                  10
                  12
                  33
               
               
                  
                  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
                  
                  6
                  6
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  8
                  10
                  31
               
               
                  3020
                  Outlays (gross)
                  â2
                  â10
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6
                  6
                  20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  6
                  6
               
               
                  3200
                  Obligated balance, end of year
                  6
                  6
                  20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  10
                  10
                  31
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2
                  4
                  12
               
               
                  4011
                  Outlays from discretionary balances
                  
                  6
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2
                  10
                  17
               
               
                  4180
                  Budget authority, net (total)
                  10
                  10
                  31
               
               
                  4190
                  Outlays, net (total)
                  2
                  10
                  17
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  2
                  2
                  8
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  5
                  10
               
               
                  31.0
                  Equipment
                  
                  
                  5
               
               
                  32.0
                  Land and structures
                  1
                  3
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  8
                  10
                  31
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital Fund                                                                                                 
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  CDC Working Capital Fund (Direct)
                  2
                  
                  
               
               
                  0801
                  CDC Working Capital Fund (Reimbursable)
                  521
                  545
                  545
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  523
                  545
                  545
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  27
                  52
                  52
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  2
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  30
                  52
                  52
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  545
                  545
                  545
               
               
                  1930
                  Total budgetary resources available
                  575
                  597
                  597
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  52
                  52
                  52
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  150
                  175
                  9
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  523
                  545
                  545
               
               
                  3020
                  Outlays (gross)
                  â497
                  â711
                  â545
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  175
                  9
                  9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  150
                  175
                  9
               
               
                  3200
                  Obligated balance, end of year
                  175
                  9
                  9
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  545
                  545
                  545
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  365
                  545
                  545
               
               
                  4011
                  Outlays from discretionary balances
                  132
                  166
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  497
                  711
                  545
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â545
                  â545
                  â545
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â48
                  166
                  
               
               
                  
                     
                  
               
            
         
      
      
         Implemented in fiscal year 2014, CDC's 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 075â4553â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  25.3
                  Direct obligations: Other goods and services from Federal sources
                  2
                  
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  137
                  157
                  157
               
               
                  11.3
                  Other than full-time permanent
                  3
                  3
                  3
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  146
                  166
                  166
               
               
                  12.1
                  Civilian personnel benefits
                  45
                  46
                  46
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  33
                  33
                  33
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  35
                  35
                  35
               
               
                  25.1
                  Advisory and assistance services
                  25
                  25
                  25
               
               
                  25.2
                  Other services from non-Federal sources
                  73
                  78
                  78
               
               
                  25.3
                  Other goods and services from Federal sources
                  58
                  63
                  63
               
               
                  25.4
                  Operation and maintenance of facilities
                  37
                  37
                  37
               
               
                  25.7
                  Operation and maintenance of equipment
                  42
                  42
                  42
               
               
                  26.0
                  Supplies and materials
                  2
                  2
                  2
               
               
                  31.0
                  Equipment
                  14
                  7
                  7
               
               
                  32.0
                  Land and structures
                  8
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  521
                  545
                  545
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  523
                  545
                  545
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,486
                  1,486
                  1,486
               
               
                  2101
                  Reimbursable military average strength employment
                  28
                  28
                  28
               
               
                  
                     
                  
               
            
         
      
         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)
         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) of CERCLA during fiscal year [2016] 2017, and existing profiles may be updated as necessary. (Department of the Interior, Environment, and Related Agencies Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Agency for Toxic Substances and Disease Registry, Toxic Substanc (Direct)
                  74
                  75
                  75
               
               
                  0002
                  Health Reform Prog. Grants Environ. Hazzards
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  77
                  75
                  75
               
               
                  0801
                  Agency for Toxic Substances and Disease Registry, Toxic Substanc (Reimbursable)
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  83
                  81
                  81
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  12
                  27
                  24
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  3
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  74
                  75
                  75
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  20
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  19
                  
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2
                  3
                  3
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  5
                  3
                  3
               
               
                  1900
                  Budget authority (total)
                  98
                  78
                  78
               
               
                  1930
                  Total budgetary resources available
                  110
                  105
                  102
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  27
                  24
                  21
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  45
                  44
                  38
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  83
                  81
                  81
               
               
                  3020
                  Outlays (gross)
                  â81
                  â87
                  â84
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  44
                  38
                  35
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â7
                  â5
                  â5
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  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
                  38
                  39
                  33
               
               
                  3200
                  Obligated balance, end of year
                  39
                  33
                  30
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  79
                  78
                  78
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  52
                  53
                  53
               
               
                  4011
                  Outlays from discretionary balances
                  27
                  26
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  79
                  79
                  75
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â7
                  â3
                  â3
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  74
                  75
                  75
               
               
                  4080
                  Outlays, net (discretionary)
                  72
                  76
                  72
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  19
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  2
                  8
                  9
               
               
                  4180
                  Budget authority, net (total)
                  93
                  75
                  75
               
               
                  4190
                  Outlays, net (total)
                  74
                  84
                  81
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  23
                  21
                  21
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  29
                  27
                  27
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  7
                  8
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  2
               
               
                  25.1
                  Advisory and assistance services
                  6
                  8
                  8
               
               
                  25.2
                  Other services from non-Federal sources
                  4
                  5
                  4
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  11
                  10
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  17
                  15
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  77
                  75
                  75
               
               
                  99.0
                  Reimbursable obligations
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  83
                  81
                  81
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  219
                  229
                  229
               
               
                  1101
                  Direct military average strength employment
                  36
                  36
                  36
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program Fund                                                                                   
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal Share
                  261
                  300
                  335
               
               
                  0002
                  NYC
                  29
                  33
                  37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  290
                  333
                  372
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  30
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (WTC (CDC Direct))
                  272
                  330
                  346
               
               
                  1200
                  Appropriation (WTCâNYC DHSSâCDC)
                  31
                  33
                  35
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  280
                  363
                  381
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  10
                  
                  
               
               
                  1900
                  Budget authority (total)
                  290
                  363
                  381
               
               
                  1930
                  Total budgetary resources available
                  290
                  363
                  411
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  30
                  39
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  153
                  161
                  230
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  290
                  333
                  372
               
               
                  3011
                  Obligations incurred, expired accounts
                  9
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â261
                  â264
                  â301
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  161
                  230
                  301
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  153
                  161
                  230
               
               
                  3200
                  Obligated balance, end of year
                  161
                  230
                  301
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  290
                  363
                  381
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  176
                  167
                  175
               
               
                  4101
                  Outlays from mandatory balances
                  85
                  97
                  126
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  261
                  264
                  301
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â23
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  280
                  363
                  381
               
               
                  4170
                  Outlays, net (mandatory)
                  238
                  264
                  301
               
               
                  4180
                  Budget authority, net (total)
                  280
                  363
                  381
               
               
                  4190
                  Outlays, net (total)
                  238
                  264
                  301
               
               
                  
                     
                  
               
            
         
      
      
         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 World Trade Center (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 WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
            Compensation Reauthorization Act of 2015 (P.L. 114â113, Division O, Title III). The amounts included for 2016 and 2017 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2015 actual
                  2016 est.
                  2017 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
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  24
                  24
                  24
               
               
                  25.2
                  Other services from non-Federal sources
                  67
                  67
                  67
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  11
                  11
               
               
                  25.6
                  Medical care
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  23
                  23
                  23
               
               
                  42.0
                  Insurance claims and indemnities
                  160
                  203
                  242
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  290
                  333
                  372
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  15
                  15
                  15
               
               
                  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, [$5,214,701,000] $5,097,287,000, of which up to [$16,000,000]$50,000,000 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, 2016.)
         national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
         and blood products, [$3,115,538,000] $3,069,901,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$415,582,000] $404,560,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$1,818,357,000] $1,786,086,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$1,696,139,000] $1,659,416,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$4,629,928,000] $4,700,548,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, [$2,512,073,000] $2,434,144,000, of which [$780,000,000] $847,489,000 shall be from funds available under section 241 of the PHS Act [: Provided, That not less than $320,840,000 is provided for the Institutional Development Awards program]. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$1,339,802,000] $1,316,607,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, [$715,903,000] $687,249,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, [$693,702,000] $681,613,000. (Department of Health and Human Services Appropriations Act, 2016.)
         National institute of environmental health sciencesFor necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
         section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (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, 2016.)
         national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging, [$1,600,191,000] $1,265,133,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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,
         [$542,141,000] $532,753,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$423,031,000] $416,146,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, [$146,485,000] $143,942,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$467,700,000] $459,578,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, [$1,077,488,000] $1,020,459,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, [$1,548,390,000] $1,459,700,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, [$518,956,000] $509,762,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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, [$346,795,000] $334,025,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national center for complementary and integrative healthFor carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, [$130,789,000] $126,673,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national institute on minority health and health disparitiesFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
         [$279,718,000] $279,680,000. (Department of Health and Human Services Appropriations Act, 2016.)
         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), [$70,447,000] $69,175,000. (Department of Health and Human Services Appropriations Act, 2016.)
         national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, [$394,664,000] $395,110,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30,
         [2017] 2018: Provided further, That in fiscal year [2016] 2017, 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"). (Department of Health and Human Services Appropriations Act, 2016.)
         national center for advancing translational sciencesFor carrying out section 301 and title IV of the PHS Act with respect to translational sciences, [$685,417,000] $660,131,000: Provided, That up to $25,835,000  shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network [:  Provided further, That at least $500,000,000 is provided to the Clinical and Translational Sciences Awards program]. (Department of Health and Human Services Appropriations Act, 2016.)
         office of the directorFor carrying out the responsibilities of the Office of the Director, NIH, [$1,558,600,000] $1,432,859,000, of which up to [$30,000,000] $40,000,000 may be used to carry out section [215] 213 of this Act: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That 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 Follow-on: Provided further, That NIH shall submit a spend plan on the next phase of the study in the previous proviso to the Committees on Appropriations
         of the House of Representatives and the Senate not later than 90 days after the date of enactment of this Act:] Provided further, That [$663,039,000] $553,039,000 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 up to [$130,000,000] $20,000,000 of the funds provided to the Common Fund are available to support the trans-NIH Precision Medicine Initiative: [Provided further, That of the amount provided to the NIH, the Director of the NIH shall enter into an agreement with the National Academy
         of Sciences, as part of the studies conducted under section 489 of the PHS Act, to conduct a comprehensive study on policies
         affecting the next generation of researchers in the United States:] Provided further, That, [of the funds from Institute, Center, and Office of the Director accounts within "Department of Health and Human Services,
         National Institutes of Health,"] in order to strengthen privacy protections for human research participants, NIH shall require investigators receiving NIH
         funding, from amounts appropriated in this Act to NIH accounts, for new and competing research projects designed to generate and analyze large volumes of data derived from human research
         participants to obtain a certificate of confidentiality: 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 discretionary 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.
      
      In addition to other funds appropriated for the Common Fund established under section 402A(c) of the PHS Act, $12,600,000
         is appropriated to the Common Fund from the 10-year Pediatric Research Initiative Fund described in section 9008 of title
         26, United States Code, for the purpose of carrying out section 402(b)(7)(B)(ii) of the PHS Act (relating to pediatric research),
         as authorized in the Gabriella Miller Kids First Research Act. (Department of Health and Human Services Appropriations Act, 2016.)
         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,
         $128,863,000 , to remain available through September 30, [2020] 2021. (Department of Health and Human Services Appropriations Act, 2016.)
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  1
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Cooperative Research and Development Agreements, NIH
                  28
                  17
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  28
                  17
                  18
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  National Institutes of Health
                  â28
                  â16
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  1
                  2
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  National Cancer Institute (0849)
                  4,952
                  5,203
                  5,078
               
               
                  0002
                  National Heart, Lung, and Blood Institute (0872)
                  2,996
                  3,107
                  3,050
               
               
                  0003
                  National Institute of Dental and Craniofacial Research (0873)
                  398
                  411
                  403
               
               
                  0004
                  National Institute of Diabetes and Digestive and Kidney Disease (0884)
                  1,749
                  1,965
                  1,921
               
               
                  0005
                  National Institute of Neurological Disorders and Stroke (0886)
                  1,605
                  1,694
                  1,645
               
               
                  0006
                  National Institute of Allergy and Infectious Diseases (0885)
                  4,604
                  4,708
                  4,680
               
               
                  0007
                  National Institute of General Medical Sciences (0851)
                  1,657
                  1,660
                  1,577
               
               
                  0008
                  National Institute of Child Health and Human Development (0844)
                  1,287
                  1,334
                  1,317
               
               
                  0009
                  National Eye Institute (0887)
                  677
                  705
                  686
               
               
                  0010
                  National Institute of Environmental Health Sciences (0862)
                  745
                  768
                  755
               
               
                  0011
                  National Institute on Aging (0843)
                  1,197
                  1,591
                  1,254
               
               
                  0012
                  National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                  521
                  539
                  533
               
               
                  0013
                  National Institute on Deafness and Other Communication Disorder (0890)
                  405
                  420
                  416
               
               
                  0014
                  National Institute of Mental Health (0892)
                  1,434
                  1,512
                  1,449
               
               
                  0015
                  National Institute on Drug Abuse (0893)
                  1,016
                  1,046
                  1,010
               
               
                  0016
                  National Institute on Alcohol Abuse and Alcoholism (0894)
                  447
                  465
                  455
               
               
                  0017
                  National Institute of Nursing Research (0889)
                  141
                  143
                  142
               
               
                  0018
                  National Human Genome Research Institute (0891)
                  499
                  510
                  508
               
               
                  0019
                  National Institute of Biomedical Imaging and Bioengineering (0898)
                  327
                  340
                  334
               
               
                  0021
                  National Center for Complementary and Integrative Health (0896)
                  124
                  127
                  127
               
               
                  0022
                  National Institute on Minority Health and Health Disparities (0897)
                  270
                  278
                  278
               
               
                  0023
                  John E. Fogarty International Center (0819)
                  68
                  70
                  69
               
               
                  0024
                  National Library of Medicine (0807)
                  337
                  393
                  393
               
               
                  0025
                  Office of the Director (0846)
                  1,414
                  1,560
                  1,435
               
               
                  0026
                  Buildings and facilities (0838)
                  115
                  128
                  129
               
               
                  0027
                  Cooperative Research and Development Agreements
                  24
                  16
                  16
               
               
                  0028
                  National Center for Advancing Translational Sciences (0875)
                  633
                  685
                  656
               
               
                  0031
                  Type 1 Diabetes
                  150
                  150
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  29,792
                  31,528
                  30,466
               
               
                  0801
                  Reimbursable - Other
                  3,440
                  3,349
                  3,543
               
               
                  0802
                  Royalties
                  95
                  105
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  3,535
                  3,454
                  3,648
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  3,535
                  3,454
                  3,648
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  33,327
                  34,982
                  34,114
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  725
                  722
                  539
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  725
                  722
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  800
                  722
                  539
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  29,672
                  31,368
                  30,301
               
               
                  1121
                  Appropriations transferred from other acct [075â5736]
                  13
                  13
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  29,685
                  31,381
                  30,314
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  150
                  150
                  150
               
               
                  1201
                  Appropriation (special or trust fund)
                  28
                  16
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  178
                  166
                  166
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  3,247
                  3,252
                  3,559
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  164
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  3,411
                  3,252
                  3,559
               
               
                  1900
                  Budget authority (total)
                  33,274
                  34,799
                  34,039
               
               
                  1930
                  Total budgetary resources available
                  34,074
                  35,521
                  34,578
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â25
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  722
                  539
                  464
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  31,700
                  31,352
                  32,861
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  8
                  
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  33,327
                  34,982
                  34,114
               
               
                  3011
                  Obligations incurred, expired accounts
                  288
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â33,380
                  â33,473
                  â35,314
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â75
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â516
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  31,352
                  32,861
                  31,661
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,559
                  â979
                  â979
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  â8
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â164
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  752
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â979
                  â979
                  â979
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  30,141
                  30,373
                  31,882
               
               
                  3200
                  Obligated balance, end of year
                  30,373
                  31,882
                  30,682
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  33,096
                  34,633
                  33,873
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  9,274
                  11,725
                  11,744
               
               
                  4011
                  Outlays from discretionary balances
                  23,991
                  21,582
                  23,403
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  33,265
                  33,307
                  35,147
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â3,907
                  â3,252
                  â3,559
               
               
                  4033
                  Non-Federal sources
                  â179
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,086
                  â3,252
                  â3,559
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â164
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  839
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  675
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  29,685
                  31,381
                  30,314
               
               
                  4080
                  Outlays, net (discretionary)
                  29,179
                  30,055
                  31,588
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  178
                  166
                  166
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  52
                  52
               
               
                  4101
                  Outlays from mandatory balances
                  114
                  114
                  115
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  115
                  166
                  167
               
               
                  4180
                  Budget authority, net (total)
                  29,863
                  31,547
                  30,480
               
               
                  4190
                  Outlays, net (total)
                  29,294
                  30,221
                  31,755
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  29,863
                  31,547
                  30,480
               
               
                  
                  Outlays
                  29,294
                  30,221
                  31,755
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  1,825
               
               
                  
                  Outlays
                  
                  
                  547
               
               
                  Total:
               
               
                  
                  Budget Authority
                  29,863
                  31,547
                  32,305
               
               
                  
                  Outlays
                  29,294
                  30,221
                  32,302
               
               
                  
                     
                  
               
            
         
      
      
         DISTRIBUTION OF PROGRAM LEVEL FUNDING AND OUTLAYS BY ACCOUNT (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2015*
                     2016
                     2017
                  
                  
                     
                        
                     
                  
                  
                     Distribution of Program Level Funding by account:
                     
                     
                     
                  
                  
                     National Cancer Institute
                     4,953
                     5,214
                     5,894
                  
                  
                     National Heart, Lung, and Blood Institute
                     2,996
                     3,114
                     3,114
                  
                  
                     National Institute of Dental and Craniofacial Research
                     398
                     414
                     413
                  
                  
                     National Institute of Diabetes and Digestive and Kidney Diseases
                     1,899
                     1,996
                     1,966
                  
                  
                     National Institute of Neurological Disorder and Stroke
                     1,605
                     1,695
                     1,695
                  
                  
                     National Institute of Allergy and Infectious Diseases
                     4,418
                     4,716
                     4,716
                  
                  
                     National Institute of General Medical Sciences
                     2,372
                     2,512
                     2,512
                  
                  
                     Eunice Kennedy Shriver National Institute of Child Health and Human Development
                     1,287
                     1,338
                     1,338
                  
                  
                     National Eye Institute
                     677
                     708
                     708
                  
                  
                     National Institute of Environmental Health Sciences
                     745
                     771
                     771
                  
                  
                     National Institute on Aging
                     1,198
                     1,598
                     1,598
                  
                  
                     National Institute of Arthritis and Musculoskeletal and Skin Diseases
                     522
                     542
                     542
                  
                  
                     National Institute on Deafness and Other Communication Disorders
                     405
                     423
                     423
                  
                  
                     National Institute of Nursing Research
                     141
                     146
                     146
                  
                  
                     National Institute on Alcohol Abuse and Alcoholism
                     447
                     467
                     467
                  
                  
                     National Institute on Drug Abuse
                     1,016
                     1,051
                     1,051
                  
                  
                     National Institute of Mental Health
                     1,434
                     1,519
                     1,519
                  
                  
                     National Human Genome Research Institute
                     499
                     513
                     513
                  
                  
                     National Institute of Biomedical Imaging and Bioengineering
                     327
                     344
                     344
                  
                  
                     National Center for Complementary and Integrative Health
                     124
                     130
                     130
                  
                  
                     National Institute on Minority Health and Health Disparities
                     271
                     281
                     281
                  
                  
                     John E. Fogarty International Center
                     68
                     70
                     70
                  
                  
                     National Library of Medicine
                     337
                     396
                     396
                  
                  
                     National Center for Advancing Translational Sciences
                     633
                     685
                     685
                  
                  
                     Office of the Director
                     1,414
                     1,571
                     1,716
                  
                  
                     Buildings and Facilities
                     129
                     129
                     129
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Program Level, NIH
                     30,311
                     32,311
                     33,136
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2015
                     2016
                     2017
                  
                  
                     
                        
                     
                  
                  
                     Distribution of Outlays by account:
                     
                     
                     
                  
                  
                     National Cancer Institute
                     4,914
                     5,083
                     5,902
                  
                  
                     National Heart, Lung, and Blood Institute
                     2,992
                     2,874
                     3,076
                  
                  
                     National Institute of Dental and Craniofacial Research
                     410
                     406
                     409
                  
                  
                     National Institute of Diabetes and Digestive and Kidney Diseases
                     1,843
                     2,084
                     1,795
                  
                  
                     National Institute of Neurological Disorders and Stroke
                     1,569
                     1,728
                     1,675
                  
                  
                     National Institute of Allergy and Infectious Diseases
                     4,361
                     3,987
                     4,625
                  
                  
                     National Institute of General Medical Sciences
                     1,592
                     1,698
                     1,735
                  
                  
                     Eunice Kennedy Shriver National Institute of Child Health and Human Development
                     1,322
                     1,345
                     1,325
                  
                  
                     National Eye Institute
                     677
                     660
                     700
                  
                  
                     National Institute of Environmental Health Sciences
                     716
                     752
                     699
                  
                  
                     National Institute on Aging
                     1,062
                     1,339
                     1,508
                  
                  
                     National Institute of Arthritis and Musculoskeletal and Skin Diseases
                     516
                     525
                     536
                  
                  
                     National Institute on Deafness and Other Communication Disorders
                     407
                     401
                     419
                  
                  
                     National Institute of Nursing Research
                     150
                     129
                     144
                  
                  
                     National Institute on Alcohol Abuse and Alcoholism
                     467
                     424
                     461
                  
                  
                     National Institute on Drug Abuse
                     1,030
                     933
                     1,038
                  
                  
                     National Institute of Mental Health
                     1,415
                     1,455
                     1,500
                  
                  
                     National Human Genome Research Institute
                     504
                     545
                     510
                  
                  
                     National Institute of Biomedical Imaging and Bioengineering
                     334
                     316
                     338
                  
                  
                     National Center for Complementary and Integrative Health
                     125
                     124
                     128
                  
                  
                     National Institute on Minority Health and Health Disparities
                     255
                     233
                     276
                  
                  
                     John E. Fogarty International Center
                     65
                     74
                     69
                  
                  
                     National Library of Medicine
                     393
                     290
                     388
                  
                  
                     National Center for Advancing Translational Sciences
                     591
                     570
                     674
                  
                  
                     Office of the Director
                     1,364
                     1,374
                     1,517
                  
                  
                     Buildings and Facilities
                     99
                     113
                     121
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Outlays, NIH
                     29,173
                     29,462
                     30,835
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         *In addition, the FY 2015 appropriation (P.L. 113â235) provided NIH $239 million of emergency resources for Ebola response
         and preparedness research activities.
         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 075â9915â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  915
                  969
                  977
               
               
                  11.3
                  Other than full-time permanent
                  463
                  472
                  476
               
               
                  11.5
                  Other personnel compensation
                  33
                  36
                  36
               
               
                  11.7
                  Military personnel
                  20
                  20
                  20
               
               
                  11.8
                  Special personal services payments
                  162
                  165
                  166
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,593
                  1,662
                  1,675
               
               
                  12.1
                  Civilian personnel benefits
                  452
                  480
                  489
               
               
                  12.2
                  Military personnel benefits
                  13
                  14
                  14
               
               
                  21.0
                  Travel and transportation of persons
                  50
                  51
                  52
               
               
                  22.0
                  Transportation of things
                  5
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  22
                  22
                  23
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  25
                  26
                  27
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  120
                  118
                  137
               
               
                  25.2
                  Other services from non-Federal sources
                  1,026
                  1,101
                  1,177
               
               
                  25.3
                  Other goods and services from Federal sources
                  2,952
                  3,069
                  3,235
               
               
                  25.4
                  Operation and maintenance of facilities
                  214
                  229
                  240
               
               
                  25.5
                  Research and development contracts
                  1,558
                  1,590
                  1,701
               
               
                  25.6
                  Medical care
                  28
                  28
                  28
               
               
                  25.7
                  Operation and maintenance of equipment
                  100
                  101
                  103
               
               
                  26.0
                  Supplies and materials
                  190
                  198
                  200
               
               
                  31.0
                  Equipment
                  154
                  162
                  165
               
               
                  41.0
                  Grants, subsidies, and contributions
                  21,289
                  22,675
                  21,191
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  29,792
                  31,532
                  30,463
               
               
                  99.0
                  Reimbursable obligations
                  3,535
                  3,450
                  3,651
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  33,327
                  34,982
                  34,114
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  12,956
                  13,085
                  13,085
               
               
                  1101
                  Direct military average strength employment
                  185
                  185
                  185
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  4,577
                  4,624
                  4,624
               
               
                  2101
                  Reimbursable military average strength employment
                  105
                  106
                  106
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â4â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  National Cancer Institute (0849)
                  
                  
                  796
               
               
                  0002
                  National Heart, Lung, and Blood Institute (0872)
                  
                  
                  44
               
               
                  0003
                  National Institute of Dental and Craniofacial Research (0873)
                  
                  
                  9
               
               
                  0004
                  National Institute of Diabetes and Digestive and Kidney Disease (0884)
                  
                  
                  30
               
               
                  0005
                  National Institute of Neurological Disorders and Stroke (0886)
                  
                  
                  36
               
               
                  0006
                  National Institute of Allergy and Infectious Diseases (0885)
                  
                  
                  15
               
               
                  0007
                  National Institute of General Medical Sciences (0851)
                  
                  
                  78
               
               
                  0008
                  National Institute of Child Health and Human Development (0844)
                  
                  
                  22
               
               
                  0009
                  National Eye Institute (0887)
                  
                  
                  21
               
               
                  0010
                  National Institute of Environmental Health Sciences (0862)
                  
                  
                  12
               
               
                  0011
                  National Institute on Aging (0843)
                  
                  
                  333
               
               
                  0012
                  National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                  
                  
                  9
               
               
                  0013
                  National Institute on Deafness and Other Communication Disorder (0890)
                  
                  
                  7
               
               
                  0014
                  National Institute of Mental Health (0892)
                  
                  
                  59
               
               
                  0015
                  National Institute on Drug Abuse (0893)
                  
                  
                  30
               
               
                  0016
                  National Institute on Alcohol Abuse and Alcoholism (0894)
                  
                  
                  8
               
               
                  0017
                  National Institute of Nursing Research (0889)
                  
                  
                  2
               
               
                  0018
                  National Human Genome Research Institute (0891)
                  
                  
                  4
               
               
                  0019
                  National Institute of Biomedical Imaging and Bioengineering (0898)
                  
                  
                  9
               
               
                  0021
                  National Center for Complementary and Integrative Health (0896)
                  
                  
                  1
               
               
                  0022
                  National Institute on Minority Health and Health Disparities (0897)
                  
                  
                  3
               
               
                  0023
                  John E. Fogarty International Center (0819)
                  
                  
                  1
               
               
                  0024
                  National Library of Medicine (0807)
                  
                  
                  1
               
               
                  0025
                  Office of the Director (0846)
                  
                  
                  270
               
               
                  0028
                  National Center for Advancing Translational Sciences (0875)
                  
                  
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  1,825
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  1,900
               
               
                  1220
                  Appropriations transferred to other acct [075â9911]
                  
                  
                  â75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  1,825
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  1,825
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  1,825
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â547
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  1,278
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  1,278
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  1,825
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  547
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  1,825
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  547
               
               
                  
                     
                  
               
            
         
      
         10-Year Pediatric Research Initiative Fund                                                                               
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  38
                  26
                  13
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Transfers from Presidential Election Campaign Fund
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  39
                  26
                  13
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  10-Year Pediatric Research Initiative Fund
                  â13
                  â13
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  26
                  13
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  13
                  13
                  13
               
               
                  1120
                  Appropriations transferred to other accts [075â9915]
                  â13
                  â13
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         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, [$1,133,948,000] $1,117,727,000: 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] $31,039,000 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 in this Act for fiscal year [2016] 2017: [Provided further, That of the amount appropriated under this heading, $46,887,000 shall be for the National Child Traumatic Stress Initiative
         as described in section 582 of the PHS Act:] Provided further, That 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 10 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: Provided further, That of the funds made available under this heading, $15,000,000 shall be to carry out section 224 of the Protecting Access
         to Medicare Act of 2014 (Public Law 113â93; 42 U.S.C. 290aa 22 note): Provided further, That up to 10 percent of the amounts made available to carry out the Children's Mental Health Services
            program may be used to carry out demonstration grants or contracts for early interventions with persons not more than 25 years
            of age at clinical high risk of developing a first episode of psychosis. 
         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, [$2,114,224,000] $2,077,148,000: 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: Provided further, That notwithstanding section 508 of the PHS Act, up to 25 percent of the amounts made available to carry
            out such section may be used to carry out demonstration grants to provide intensive outpatient services and treatment as well
            as any of the services listed in section 508(d).  
         SUBSTANCE ABUSE PREVENTIONFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, [$211,219,000] $194,680,000: 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 ("SAMHSA"), [$174,878,000] $99,228,000: Provided, That in addition to amounts provided herein, [$31,428,000] $56,828,000 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, [2017] 2018: 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 discretionary funds (pursuant to the Balanced Budget and Emergency
            Deficit Control Act of 1985) which are appropriated for the current fiscal year for SAMHSA in this Act 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0006
                  Mental Health
                  1,046
                  1,134
                  1,118
               
               
                  0007
                  Substance Abuse Treatment
                  2,103
                  2,114
                  2,077
               
               
                  0008
                  Substance Abuse Prevention
                  175
                  211
                  195
               
               
                  0009
                  Health Surveillance and Program Support
                  149
                  175
                  99
               
               
                  0011
                  Prevention Fund
                  12
                  12
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total, direct program
                  3,485
                  3,646
                  3,517
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  3,485
                  3,646
                  3,517
               
               
                  0802
                  Reimbursables
                  109
                  117
                  117
               
               
                  0810
                  Reimbursable:  PHS Evaluation
                  134
                  134
                  214
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  243
                  251
                  331
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  3,728
                  3,897
                  3,848
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,474
                  3,634
                  3,489
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [075â0116]
                  12
                  12
                  28
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  148
                  251
                  331
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  95
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  243
                  251
                  331
               
               
                  1900
                  Budget authority (total)
                  3,729
                  3,897
                  3,848
               
               
                  1930
                  Total budgetary resources available
                  3,729
                  3,897
                  3,848
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3,495
                  3,727
                  3,563
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  3,728
                  3,897
                  3,848
               
               
                  3011
                  Obligations incurred, expired accounts
                  9
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â3,396
                  â4,061
                  â3,849
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â109
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,727
                  3,563
                  3,562
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â155
                  â126
                  â126
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â95
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  124
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â126
                  â126
                  â126
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3,340
                  3,601
                  3,437
               
               
                  3200
                  Obligated balance, end of year
                  3,601
                  3,437
                  3,436
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,717
                  3,885
                  3,820
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,103
                  1,189
                  1,163
               
               
                  4011
                  Outlays from discretionary balances
                  2,253
                  2,792
                  2,667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,356
                  3,981
                  3,830
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â255
                  â249
                  â329
               
               
                  4033
                  Non-Federal sources
                  
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â255
                  â251
                  â331
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â95
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  107
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,474
                  3,634
                  3,489
               
               
                  4080
                  Outlays, net (discretionary)
                  3,101
                  3,730
                  3,499
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  12
                  12
                  28
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4
                  9
               
               
                  4101
                  Outlays from mandatory balances
                  40
                  76
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  40
                  80
                  19
               
               
                  4180
                  Budget authority, net (total)
                  3,486
                  3,646
                  3,517
               
               
                  4190
                  Outlays, net (total)
                  3,141
                  3,810
                  3,518
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  3,486
                  3,646
                  3,517
               
               
                  
                  Outlays
                  3,141
                  3,810
                  3,518
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  590
               
               
                  
                  Outlays
                  
                  
                  183
               
               
                  Total:
               
               
                  
                  Budget Authority
                  3,486
                  3,646
                  4,107
               
               
                  
                  Outlays
                  3,141
                  3,810
                  3,701
               
               
                  
                     
                  
               
            
         
      
      
         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 075â1362â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  47
                  51
                  52
               
               
                  11.3
                  Other than full-time permanent
                  3
                  3
                  3
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  4
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  55
                  59
                  60
               
               
                  12.1
                  Civilian personnel benefits
                  15
                  16
                  17
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  10
                  9
                  6
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  2
                  2
                  1
               
               
                  25.1
                  Advisory and assistance services
                  29
                  37
                  35
               
               
                  25.2
                  Other services from non-Federal sources
                  168
                  172
                  143
               
               
                  25.3
                  Other goods and services from Federal sources
                  32
                  35
                  29
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  2
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,166
                  3,309
                  3,220
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,485
                  3,646
                  3,517
               
               
                  99.0
                  Reimbursable obligations
                  243
                  251
                  331
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  3,728
                  3,897
                  3,848
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  457
                  494
                  494
               
               
                  1101
                  Direct military average strength employment
                  38
                  41
                  41
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  104
                  114
                  114
               
               
                  2101
                  Reimbursable military average strength employment
                  20
                  16
                  16
               
               
                  
                     
                  
               
            
         
      
         Substance Abuse and Mental Health Services Administration                                                                
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0006
                  Mental Health
                  
                  
                  115
               
               
                  0007
                  Substance Abuse Treatment
                  
                  
                  475
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total, direct program
                  
                  
                  590
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  590
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  590
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  590
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  590
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  590
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â183
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  407
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  407
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  590
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  183
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  590
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  183
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and Quality                                                                               
            
         Federal Funds
         Healthcare research and qualityFor carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
         Medicare Prescription Drug, Improvement, and Modernization Act of 2003, [$334,000,000] $363,698,000, of which $83,458,000 shall be from funds available under section 241 of the PHS Act: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year [2016] 2017: Provided further, 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, 2017] expended. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Research on Health Costs, Quality and Outcomes
                  228
                  197
                  141
               
               
                  0002
                  Medical Expenditure Panel Survey
                  65
                  66
                  69
               
               
                  0003
                  Program Support
                  70
                  71
                  71
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  363
                  334
                  281
               
               
                  0803
                  Research on Health Costs, Quality and Outcomes
                  18
                  18
                  102
               
               
                  0805
                  Program Support
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  19
                  18
                  102
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  382
                  352
                  383
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  18
                  16
                  13
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  20
                  16
                  13
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  364
                  334
                  280
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1
                  15
                  15
               
               
                  1700
                  Collected
                  
                  
                  83
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  14
                  15
                  98
               
               
                  1900
                  Budget authority (total)
                  378
                  349
                  378
               
               
                  1930
                  Total budgetary resources available
                  398
                  365
                  391
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  16
                  13
                  8
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  417
                  392
                  534
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  382
                  352
                  383
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â375
                  â210
                  â492
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  392
                  534
                  425
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â361
                  â156
                  â156
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  218
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â156
                  â156
                  â156
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  56
                  236
                  378
               
               
                  3200
                  Obligated balance, end of year
                  236
                  378
                  269
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  378
                  349
                  378
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  136
                  132
                  196
               
               
                  4011
                  Outlays from discretionary balances
                  233
                  76
                  296
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  369
                  208
                  492
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â200
                  â15
                  â98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â200
                  â15
                  â98
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  199
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  186
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  364
                  334
                  280
               
               
                  4080
                  Outlays, net (discretionary)
                  169
                  193
                  394
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  2
                  
               
               
                  4180
                  Budget authority, net (total)
                  364
                  334
                  280
               
               
                  4190
                  Outlays, net (total)
                  175
                  195
                  394
               
               
                  
                     
                  
               
            
         
      
      
         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 075â1700â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  31
                  33
                  33
               
               
                  11.3
                  Other than full-time permanent
                  3
                  3
                  3
               
               
                  11.5
                  Other personnel compensation
                  1
                  
                  1
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  36
                  37
                  38
               
               
                  12.1
                  Civilian personnel benefits
                  10
                  10
                  10
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  5
                  4
                  4
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  13
                  14
                  15
               
               
                  25.3
                  Other goods and services from Federal sources
                  19
                  20
                  20
               
               
                  25.5
                  Research and development contracts
                  158
                  129
                  92
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  117
                  114
                  98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  363
                  333
                  281
               
               
                  99.0
                  Reimbursable obligations
                  19
                  19
                  102
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  382
                  352
                  383
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  281
                  294
                  294
               
               
                  1101
                  Direct military average strength employment
                  6
                  6
                  6
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  5
                  6
                  6
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  10
                  25
                  25
               
               
                  
                     
                  
               
            
         
      
         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, [$243,545,410,000] $262,003,967,000, to remain available until expended.
      
      [For making,] In addition, for carrying out such titles after May 31, [2016, 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] 2017 for the last quarter of fiscal year [2016] 2017 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary, to remain available until expended.
      
      [For making payments to States or in the case of section 1928 on behalf of States under title XIX of the Social Security Act] In addition, for carrying out such titles for the first quarter of fiscal year [2017] 2018, [$115,582,502,000] $125,219,452,000, 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  354,018
                  345,718
                  354,224
               
               
                  0002
                  State and local administration
                  20,284
                  18,870
                  18,976
               
               
                  0003
                  Vaccines for Children
                  3,845
                  4,161
                  4,386
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  378,147
                  368,749
                  377,586
               
               
                  0801
                  Medicare Part B premiums
                  749
                  869
                  954
               
               
                  0802
                  Medicare Part D
                  
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  749
                  872
                  957
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  378,896
                  369,621
                  378,543
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,407
                  343
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  22,150
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  23,557
                  343
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  4
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  251,444
                  255,134
                  262,000
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  103,472
                  113,272
                  115,582
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  766
                  872
                  957
               
               
                  1900
                  Budget authority (total)
                  355,682
                  369,278
                  378,543
               
               
                  1930
                  Total budgetary resources available
                  379,239
                  369,621
                  378,543
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  343
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  36,003
                  42,221
                  43,741
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  378,896
                  369,621
                  378,543
               
               
                  3020
                  Outlays (gross)
                  â350,528
                  â368,101
                  â377,547
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â22,150
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  42,221
                  43,741
                  44,737
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  36,003
                  42,221
                  43,741
               
               
                  3200
                  Obligated balance, end of year
                  42,221
                  43,741
                  44,737
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  4
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  4
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  355,682
                  369,278
                  378,539
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  316,021
                  327,399
                  377,543
               
               
                  4101
                  Outlays from mandatory balances
                  34,507
                  40,702
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  350,528
                  368,101
                  377,543
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â749
                  â872
                  â957
               
               
                  4123
                  Non-Federal sources
                  â17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â766
                  â872
                  â957
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  354,916
                  368,406
                  377,582
               
               
                  4170
                  Outlays, net (mandatory)
                  349,762
                  367,229
                  376,586
               
               
                  4180
                  Budget authority, net (total)
                  354,916
                  368,406
                  377,586
               
               
                  4190
                  Outlays, net (total)
                  349,762
                  367,229
                  376,590
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  354,916
                  368,406
                  377,586
               
               
                  
                  Outlays
                  349,762
                  367,229
                  376,590
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  
                  â14
               
               
                  
                  Outlays
                  
                  
                  â14
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  28
               
               
                  
                  Outlays
                  
                  
                  28
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  8,982
               
               
                  
                  Outlays
                  
                  
                  8,982
               
               
                  Total:
               
               
                  
                  Budget Authority
                  354,916
                  368,406
                  386,582
               
               
                  
                  Outlays
                  349,762
                  367,229
                  385,586
               
               
                  
                     
                  
               
            
         
      
      
         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
                     2015
                     2016
                     2017
                  
                  
                     
                        
                     
                  
                  
                     Vaccine Purchase
                     3,558
                     3,973
                     4,072
                  
                  
                     Vaccine Stockpile
                     122
                     9
                     131
                  
                  
                     Ordering, Distribution, and Operations
                     127
                     131
                     134
                  
                  
                     Vaccine Management Contract Support
                     0
                     0
                     0
                  
                  
                     Evaluation Activities
                     44
                     48
                     50
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Obligations
                     3,851
                     4,161
                     4,387
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  378,147
                  368,749
                  377,586
               
               
                  99.0
                  Reimbursable obligations
                  749
                  872
                  957
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  378,896
                  369,621
                  378,543
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â7â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  
                  â14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â14
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â14
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â14
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â14
               
               
                  3020
                  Outlays (gross)
                  
                  
                  14
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â14
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â14
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â14
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â14
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â2â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  28
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  
                  
                  28
               
               
                  1900
                  Budget authority (total)
                  
                  
                  28
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  28
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â28
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  28
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  28
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  28
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  28
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the non-PAYGO 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 075â0512â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid vendor payments
                  
                  
                  8,982
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  8,982
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  8,982
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation Medicaid
                  
                  
                  8,982
               
               
                  1900
                  Budget authority (total)
                  
                  
                  8,982
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  8,982
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  8,982
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â8,982
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  8,982
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  8,982
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  8,982
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  8,982
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
         State Grants and Demonstrations                                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Ticket to Work
                  1
                  
                  
               
               
                  0011
                  Emergency health services for undocumented aliens
                  5
                  2
                  
               
               
                  0012
                  Medicaid integrity program
                  75
                  114
                  84
               
               
                  0018
                  Money follows the person (MFP) demonstration
                  546
                  1,515
                  
               
               
                  0019
                  MFP evaluations and technical support
                  1
                  1
                  
               
               
                  0023
                  Grants to improve outreach and enrollment
                  5
                  40
                  
               
               
                  0025
                  Medicaid emergency psychiatric demonstration
                  34
                  
                  
               
               
                  0026
                  Incentives for prevention of chronic diseases in Medicaid
                  7
                  
                  
               
               
                  0027
                  Demonstration Programs to Improve Mental Health Services
                  1
                  24
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  675
                  1,696
                  84
               
               
                  0801
                  Reimbursable program activity
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  680
                  1,696
                  84
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,415
                  2,252
                  1,116
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  9
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,437
                  2,252
                  1,116
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  533
                  598
                  84
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â39
                  â38
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  494
                  560
                  84
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  6
                  
                  
               
               
                  1900
                  Budget authority (total)
                  500
                  560
                  84
               
               
                  1930
                  Total budgetary resources available
                  2,937
                  2,812
                  1,200
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â5
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2,252
                  1,116
                  1,116
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  694
                  787
                  1,849
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  680
                  1,696
                  84
               
               
                  3011
                  Obligations incurred, expired accounts
                  16
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â590
                  â634
                  â543
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  787
                  1,849
                  1,390
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  694
                  787
                  1,849
               
               
                  3200
                  Obligated balance, end of year
                  787
                  1,849
                  1,390
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  500
                  560
                  84
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  58
                  21
               
               
                  4101
                  Outlays from mandatory balances
                  589
                  576
                  522
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  590
                  634
                  543
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â22
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  494
                  560
                  84
               
               
                  4170
                  Outlays, net (mandatory)
                  568
                  634
                  543
               
               
                  4180
                  Budget authority, net (total)
                  494
                  560
                  84
               
               
                  4190
                  Outlays, net (total)
                  568
                  634
                  543
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  494
                  560
                  84
               
               
                  
                  Outlays
                  568
                  634
                  543
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  525
               
               
                  
                  Outlays
                  
                  
                  25
               
               
                  Total:
               
               
                  
                  Budget Authority
                  494
                  560
                  609
               
               
                  
                  Outlays
                  568
                  634
                  568
               
               
                  
                     
                  
               
            
         
      
      
         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), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10).
         
         The Budget includes an unobligated balance of approximately $13 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 075â0516â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent - Medicaid Integrity Program
                  8
                  9
                  9
               
               
                  12.1
                  Civilian personnel benefits - Medicaid Integrity Program
                  3
                  4
                  4
               
               
                  41.0
                  Grants, subsidies, and contributions - Emergency services for undocumented aliens
                  5
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid Integrity Program
                  64
                  101
                  71
               
               
                  41.0
                  Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
                  546
                  1,515
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - MFP evaluations and technical support
                  1
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                  5
                  40
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid emergency psychiatric demonstration
                  34
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Incentives for prevention of chronic diseases in Medicaid
                  7
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Demos to Improve Mental Health
                  1
                  24
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Ticket to Work
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  675
                  1,696
                  84
               
               
                  99.0
                  Reimbursable obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  680
                  1,696
                  84
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  86
                  97
                  96
               
               
                  
                     
                  
               
            
         
      
         State Grants and Demonstrations                                                                                          
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  525
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  525
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  525
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â25
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  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, [$283,171,800,000] $299,187,700,000.
      
      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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  188,348
                  237,231
                  214,944
               
               
                  0002
                  Part D benefits (Rx Drug)
                  72,342
                  82,453
                  82,512
               
               
                  0003
                  Part D Federal administration (Rx Drug)
                  418
                  691
                  405
               
               
                  0004
                  General Fund Transfers to HI
                  1,103
                  1,493
                  1,324
               
               
                  0006
                  Federal Bureau of Investigation (HCFAC)
                  129
                  130
                  141
               
               
                  0007
                  Federal payments from taxation of OASDI benefits (HI)
                  20,208
                  23,208
                  25,987
               
               
                  0008
                  Criminal fines (HCFAC)
                  57
                  550
                  590
               
               
                  0009
                  Civil penalties and damages (HCFAC - DOJ and CMS administration)
                  15
                  32
                  32
               
               
                  0010
                  Asset Forfeiture
                  15
                  29
                  30
               
               
                  0011
                  State Low Income Determinations
                  
                  5
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  282,635
                  345,822
                  325,968
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  268,206
                  283,172
                  299,188
               
               
                  1200
                  Appropriation (indefinite, permanent)
                  20,208
                  23,208
                  25,987
               
               
                  1200
                  Appropriation (HCFAC for FBI)
                  129
                  130
                  141
               
               
                  1200
                  Appropriation (indefinite for HCFAC)
                  87
                  611
                  652
               
               
                  1200
                  Appropriation (indefinite, annual)
                  6
                  38,701
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  288,636
                  345,822
                  325,968
               
               
                  1930
                  Total budgetary resources available
                  288,636
                  345,822
                  325,968
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â6,001
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  16,314
                  14,161
                  20,916
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  282,635
                  345,822
                  325,968
               
               
                  3011
                  Obligations incurred, expired accounts
                  562
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â284,944
                  â339,067
                  â325,712
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â406
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  14,161
                  20,916
                  21,172
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  16,314
                  14,161
                  20,916
               
               
                  3200
                  Obligated balance, end of year
                  14,161
                  20,916
                  21,172
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  288,636
                  345,822
                  325,968
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  273,294
                  325,614
                  325,712
               
               
                  4101
                  Outlays from mandatory balances
                  11,650
                  13,453
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  284,944
                  339,067
                  325,712
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â130
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  130
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  288,636
                  345,822
                  325,968
               
               
                  4170
                  Outlays, net (mandatory)
                  284,814
                  339,067
                  325,712
               
               
                  4180
                  Budget authority, net (total)
                  288,636
                  345,822
                  325,968
               
               
                  4190
                  Outlays, net (total)
                  284,814
                  339,067
                  325,712
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  288,636
                  345,822
                  325,968
               
               
                  
                  Outlays
                  284,814
                  339,067
                  325,712
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â819
               
               
                  
                  Outlays
                  
                  
                  â819
               
               
                  Total:
               
               
                  
                  Budget Authority
                  288,636
                  345,822
                  325,149
               
               
                  
                  Outlays
                  284,814
                  339,067
                  324,893
               
               
                  
                     
                  
               
            
         
      
      
         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 administrative expenses that are
            properly chargeable to the general fund.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  280,927
                  343,638
                  324,239
               
               
                  42.0
                  Insurance claims and indemnities
                  187
                  158
                  147
               
               
                  94.0
                  Financial transfers (Federal admin)
                  1,521
                  2,026
                  1,582
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  282,635
                  345,822
                  325,968
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â2â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â179
               
               
                  0002
                  Part D benefits (Rx Drug)
                  
                  
                  â640
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â819
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â819
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â819
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â819
               
               
                  3020
                  Outlays (gross)
                  
                  
                  819
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â819
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â819
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â819
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â819
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement Organizations                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  QIO contracts
                  546
                  509
                  404
               
               
                  0002
                  QIO support contracts
                  150
                  177
                  176
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  696
                  686
                  580
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  110
                  686
                  580
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  802
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  912
                  686
                  580
               
               
                  1930
                  Total budgetary resources available
                  912
                  686
                  580
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â216
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,461
                  1,488
                  1,488
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  696
                  686
                  580
               
               
                  3020
                  Outlays (gross)
                  â669
                  â686
                  â580
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,488
                  1,488
                  1,488
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2,188
                  â2,431
                  â2,431
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â802
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  559
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2,431
                  â2,431
                  â2,431
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â727
                  â943
                  â943
               
               
                  3200
                  Obligated balance, end of year
                  â943
                  â943
                  â943
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  912
                  686
                  580
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  122
                  266
                  143
               
               
                  4101
                  Outlays from mandatory balances
                  547
                  420
                  437
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  669
                  686
                  580
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â669
                  â686
                  â580
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â802
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  559
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â243
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  50
                  50
                  50
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  50
                  50
                  50
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0519â0â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  28
                  14
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  3
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  639
                  653
                  554
               
               
                  25.3
                  Other goods and services from Federal sources
                  22
                  11
                  9
               
               
                  25.4
                  Operation and maintenance of facilities
                  6
                  5
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  696
                  686
                  580
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  204
                  226
                  227
               
               
                  
                     
                  
               
            
         
      
         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] $4,109,549,000, 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;] 1893(h) of the Social Security Act, 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, 2021] 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 [2016] 2017 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. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  2,886
                  3,215
                  3,183
               
               
                  0002
                  Federal administration
                  767
                  786
                  783
               
               
                  0003
                  State survey and certification
                  421
                  428
                  463
               
               
                  0004
                  Research, demonstrations, and evaluation projects
                  122
                  88
                  49
               
               
                  0007
                  ARRA Medicare/Medicaid HIT
                  95
                  144
                  73
               
               
                  0008
                  Risk Corridor
                  2,870
                  2,870
                  2,870
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  7,161
                  7,531
                  7,421
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  7,161
                  7,531
                  7,421
               
               
                  0801
                  Clinical laboratory improvement amendments
                  58
                  47
                  50
               
               
                  0802
                  Sale of data
                  5
                  8
                  8
               
               
                  0803
                  Coordination of benefits
                  33
                  27
                  30
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  75
                  85
                  89
               
               
                  0805
                  Provider enrollment
                  30
                  30
                  32
               
               
                  0806
                  Recovery audit contractors
                  143
                  152
                  191
               
               
                  0808
                  Marketplace User Fees
                  879
                  1,197
                  1,554
               
               
                  0810
                  Risk Adjustment Administrative Expenses
                  
                  29
                  50
               
               
                  0813
                  Other reimbursable program activity
                  219
                  11
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,442
                  1,586
                  2,027
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  8,603
                  9,117
                  9,448
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  916
                  â1,091
                  â3,979
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  95
                  â1,091
                  
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  290
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,263
                  â1,091
                  â3,979
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  193
                  68
                  3
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â14
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  179
                  64
                  3
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  2,074
                  4,345
                  4,480
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2,133
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,207
                  4,345
                  4,480
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1,303
                  1,856
                  2,157
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  681
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  34
                  76
                  92
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â121
                  â112
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,897
                  1,820
                  2,249
               
               
                  1900
                  Budget authority (total)
                  6,283
                  6,229
                  6,732
               
               
                  1930
                  Total budgetary resources available
                  7,546
                  5,138
                  2,753
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â34
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  â1,091
                  â3,979
                  â6,695
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,116
                  6,739
                  9,092
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  8,603
                  9,117
                  9,448
               
               
                  3011
                  Obligations incurred, expired accounts
                  179
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â5,883
                  â6,764
                  â6,959
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â57
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â219
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,739
                  9,092
                  11,581
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â4,465
                  â5,011
                  â5,011
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,814
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,268
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5,011
                  â5,011
                  â5,011
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â349
                  1,728
                  4,081
               
               
                  3200
                  Obligated balance, end of year
                  1,728
                  4,081
                  6,570
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,207
                  4,345
                  4,480
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,199
                  4,345
                  4,480
               
               
                  4011
                  Outlays from discretionary balances
                  2,363
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,562
                  4,345
                  4,480
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â4,286
                  â4,337
                  â4,472
               
               
                  4033
                  Non-Federal sources
                  â20
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,306
                  â4,345
                  â4,480
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,133
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,232
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  99
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  256
                  
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,076
                  1,884
                  2,252
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  362
                  1,932
                  2,252
               
               
                  4101
                  Outlays from mandatory balances
                  959
                  487
                  227
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,321
                  2,419
                  2,479
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â179
                  â244
                  â239
               
               
                  4123
                  Non-Federal sources
                  â1,137
                  â1,612
                  â1,918
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â1,316
                  â1,856
                  â2,157
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â681
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â668
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  92
                  28
                  95
               
               
                  4170
                  Outlays, net (mandatory)
                  5
                  563
                  322
               
               
                  4180
                  Budget authority, net (total)
                  92
                  28
                  95
               
               
                  4190
                  Outlays, net (total)
                  261
                  563
                  322
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  43
                  130
                  166
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  130
                  166
                  74
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  59
                  59
                  59
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  59
                  59
                  59
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  92
                  28
                  95
               
               
                  
                  Outlays
                  261
                  563
                  322
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  414
               
               
                  
                  Outlays
                  
                  
                  39
               
               
                  Total:
               
               
                  
                  Budget Authority
                  92
                  28
                  509
               
               
                  
                  Outlays
                  261
                  563
                  361
               
               
                  
                     
                  
               
            
         
      
      
         Note: The figures for the risk corridors program in this table for fiscal years 2016 and 2017 are not estimates. Amounts for
            fiscal years 2016 and 2017 are uncertain and therefore the figures in this table simply reflect imbalances between payments
            out and payments in by participating plans equal to those that occurred for fiscal year 2015. In the event of a shortfall
            over the life of the three-year Risk Corridors program, the Administration will work with Congress to provide necessary funds
            for outstanding payments.
         
         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 075â0511â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  460
                  478
                  450
               
               
                  11.3
                  Other than full-time permanent
                  13
                  16
                  16
               
               
                  11.5
                  Other personnel compensation
                  8
                  8
                  8
               
               
                  11.7
                  Military personnel
                  13
                  18
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  494
                  520
                  492
               
               
                  12.1
                  Civilian personnel benefits
                  157
                  143
                  138
               
               
                  12.2
                  Military personnel benefits
                  7
                  9
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  5
                  4
                  5
               
               
                  22.0
                  Transportation of things
                  1
                  
                  
               
               
                  23.1
                  Rental payments to GSA
                  6
                  8
                  8
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  29
                  
                  
               
               
                  24.0
                  Printing and reproduction
                  40
                  2
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  2,641
                  2,508
                  2,455
               
               
                  25.3
                  Other goods and services from Federal sources
                  72
                  9
                  8
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  
                  
               
               
                  25.5
                  Research and development contracts
                  2
                  40
                  22
               
               
                  25.6
                  Medical care
                  650
                  1,269
                  1,334
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  
                  
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  2
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  85
                  109
                  37
               
               
                  42.0
                  Insurance claims and indemnities
                  2,966
                  2,909
                  2,909
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  7,161
                  7,531
                  7,421
               
               
                  99.0
                  Reimbursable obligations
                  1,442
                  1,586
                  2,027
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  8,603
                  9,117
                  9,448
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4,306
                  4,193
                  3,927
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  109
                  118
                  72
               
               
                  1101
                  Direct military average strength employment
                  179
                  185
                  185
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  103
                  125
                  542
               
               
                  
                     
                  
               
            
         
      
         Program Management                                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  
                  
                  409
               
               
                  0002
                  Federal administration
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  
                  
                  414
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  414
               
               
                  0801
                  Federal Payment Levy Program
                  
                  
                  2
               
               
                  0802
                  Home Health Civil Monetary Penalties
                  
                  
                  1
               
               
                  0803
                  Appeals Filing Fee
                  
                  
                  4
               
               
                  0804
                  Provider Application Fee
                  
                  
                  9
               
               
                  0805
                  Clearinghouse Registration Fees
                  
                  
                  15
               
               
                  0806
                  RAC Recoveries for PI
                  
                  
                  170
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  201
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  615
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  414
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  201
               
               
                  1900
                  Budget authority (total)
                  
                  
                  615
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  615
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  615
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â240
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  375
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  375
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  615
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  240
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  
                  â201
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  414
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  39
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2015 actual
                  2016 est.
                  2017 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
                  
                  
                  411
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  414
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  201
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  615
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  20
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and U.S. Territories
                  11,349
                  13,499
                  15,901
               
               
                  0003
                  Child health quality improvement
                  4
                  26
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  11,353
                  13,525
                  15,916
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3,158
                  7,501
                  8,597
               
               
                  1011
                  Unobligated balance transfer from other acct [075â5551]
                  
                  
                  3,899
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  928
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4,087
                  7,501
                  12,496
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1120
                  Delay in transfer from other acct [075â5551]
                  
                  
                  â570
               
               
                  1130
                  Appropriations permanently reduced
                  
                  
                  â2,050
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  
                  
                  â3,899
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â6,519
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  21,061
                  19,300
                  20,400
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  
                  2,618
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â6,294
                  â4,679
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  14,767
                  14,621
                  23,018
               
               
                  1900
                  Budget authority (total)
                  14,767
                  14,621
                  16,499
               
               
                  1930
                  Total budgetary resources available
                  18,854
                  22,122
                  28,995
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7,501
                  8,597
                  13,079
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,708
                  8,722
                  7,821
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  11,353
                  13,525
                  15,916
               
               
                  3011
                  Obligations incurred, expired accounts
                  143
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â9,233
                  â14,426
                  â15,015
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â248
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,722
                  7,821
                  8,722
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,708
                  8,722
                  7,821
               
               
                  3200
                  Obligated balance, end of year
                  8,722
                  7,821
                  8,722
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â6,519
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  14,767
                  14,621
                  23,018
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  313
                  5,600
                  9,200
               
               
                  4101
                  Outlays from mandatory balances
                  8,920
                  8,826
                  5,815
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  9,233
                  14,426
                  15,015
               
               
                  4180
                  Budget authority, net (total)
                  14,767
                  14,621
                  16,499
               
               
                  4190
                  Outlays, net (total)
                  9,233
                  14,426
                  15,015
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  14,767
                  14,621
                  16,499
               
               
                  
                  Outlays
                  9,233
                  14,426
                  15,015
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  180
               
               
                  
                  Outlays
                  
                  
                  180
               
               
                  Total:
               
               
                  
                  Budget Authority
                  14,767
                  14,621
                  16,679
               
               
                  
                  Outlays
                  9,233
                  14,426
                  15,195
               
               
                  
                     
                  
               
            
         
      
      
         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. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10, MACRA)
            extended funding for CHIP for two years, through 2017. The Budget proposes a two-year extension of CHIP funding through 2019.
         
      
         Children's Health Insurance Fund                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  180
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  180
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  180
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â180
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â180
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â180
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  180
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  180
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  180
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  180
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Children's Health Insurance Program (CHIP) proposals.
      
         Center for Medicare and Medicaid Innovation                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Administration
                  257
                  345
                  350
               
               
                  0002
                  Innovation Activities
                  1,095
                  1,484
                  1,133
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,352
                  1,829
                  1,483
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  7,009
                  5,669
                  3,840
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7,021
                  5,669
                  3,840
               
               
                  1930
                  Total budgetary resources available
                  7,021
                  5,669
                  3,840
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5,669
                  3,840
                  2,357
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,114
                  1,483
                  1,904
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,352
                  1,829
                  1,483
               
               
                  3020
                  Outlays (gross)
                  â971
                  â1,408
                  â1,595
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,483
                  1,904
                  1,792
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,114
                  1,483
                  1,904
               
               
                  3200
                  Obligated balance, end of year
                  1,483
                  1,904
                  1,792
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  971
                  1,408
                  1,595
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  971
                  1,408
                  1,595
               
               
                  
                     
                  
               
            
         
      
      
         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 Patient Protection and 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 the 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 075â0522â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  46
                  59
                  48
               
               
                  12.1
                  Civilian personnel benefits
                  15
                  18
                  15
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  3
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  650
                  796
                  645
               
               
                  41.0
                  Grants, subsidies, and contributions
                  575
                  823
                  666
               
               
                  42.0
                  Insurance claims and indemnities
                  63
                  129
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,352
                  1,829
                  1,483
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  479
                  625
                  654
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  2,048
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Interest, Child Enrollment Contingency Fund
                  3
                  39
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  3
                  39
                  2,064
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Child Enrollment Contingency Fund
                  â3
                  â39
                  â16
               
               
                  2103
                  Child Enrollment Contingency Fund
                  
                  
                  â2,048
               
               
                  2132
                  Child Enrollment Contingency Fund
                  
                  2,048
                  
               
               
                  2134
                  Child Enrollment Contingency Fund
                  
                  
                  570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â3
                  2,009
                  â1,494
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â3
                  2,009
                  â1,494
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  2,048
                  570
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and US Territories
                  53
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  53
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2,098
                  2,048
                  3,899
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0515]
                  
                  
                  â3,899
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,098
                  2,048
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Delay of transfer to other acct [075â0515]
                  
                  
                  570
               
               
                  1134
                  Appropriations precluded from obligation
                  
                  
                  â570
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  3,860
                  1,140
               
               
                  1201
                  Appropriation (special or trust fund)
                  3
                  39
                  16
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  2,048
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  
                  
                  â2,618
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  
                  â2,048
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  3
                  1,851
                  586
               
               
                  1900
                  Budget authority (total)
                  3
                  1,851
                  586
               
               
                  1930
                  Total budgetary resources available
                  2,101
                  3,899
                  586
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2,048
                  3,899
                  586
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  9
                  53
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  53
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â9
                  â53
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  53
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  9
                  53
                  
               
               
                  3200
                  Obligated balance, end of year
                  53
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  3
                  1,851
                  586
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  9
                  53
                  
               
               
                  4180
                  Budget authority, net (total)
                  3
                  1,851
                  586
               
               
                  4190
                  Outlays, net (total)
                  9
                  53
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  2,101
                  2,053
                  3,899
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  2,053
                  3,899
                  1,156
               
               
                  
                     
                  
               
            
         
      
      
         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 Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended the Contingency
            Fund through 2017.  The Budget proposes a two-year extension of CHIP funding, including an extension of the Contingency Fund
            through 2019. 
         
         The Fund received an initial appropriation equal to 20 percent of the FY 2009 national allotment ($2.1 billion). In fiscal
            years 2010 through 2017, 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 075â0508â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Incentive payments to hospitals
                  2,690
                  2,040
                  1,005
               
               
                  0802
                  Incentive payments to eligible professionals
                  1,592
                  760
                  440
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  4,282
                  2,800
                  1,445
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  162
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected from the HI Trust Fund
                  3,196
                  2,040
                  1,005
               
               
                  1800
                  Collected from the SMI Trust Fund
                  1,862
                  760
                  440
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â938
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  4,120
                  2,800
                  1,445
               
               
                  1930
                  Total budgetary resources available
                  4,282
                  2,800
                  1,445
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  729
                  51
                  51
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4,282
                  2,800
                  1,445
               
               
                  3020
                  Outlays (gross)
                  â4,960
                  â2,800
                  â1,445
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  51
                  51
                  51
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1,165
                  â227
                  â227
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  938
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â227
                  â227
                  â227
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â436
                  â176
                  â176
               
               
                  3200
                  Obligated balance, end of year
                  â176
                  â176
                  â176
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,120
                  2,800
                  1,445
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  4,120
                  2,749
                  1,394
               
               
                  4101
                  Outlays from mandatory balances
                  840
                  51
                  51
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,960
                  2,800
                  1,445
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â5,058
                  â2,800
                  â1,445
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  938
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â98
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â98
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  133
                  133
                  133
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  133
                  133
                  133
               
               
                  
                     
                  
               
            
         
      
         Rate Review Grants                                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0112â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Premium rate review grants
                  
                  22
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  22
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  7
                  10
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  7
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7
                  32
                  35
               
               
                  1930
                  Total budgetary resources available
                  7
                  32
                  35
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7
                  10
                  35
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  156
                  105
                  73
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  22
                  
               
               
                  3011
                  Obligations incurred, expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â35
                  â29
                  â39
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â25
                  â25
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  105
                  73
                  9
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  156
                  105
                  73
               
               
                  3200
                  Obligated balance, end of year
                  105
                  73
                  9
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  35
                  29
                  39
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  35
                  29
                  39
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act (P.L. 111â148) amended Section 2794 of the Public Health Service Act and provided
            that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
            program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
            2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
            insurance reform activities.
         
      
         Pre-Existing Condition Insurance Plan Program                                                                            
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pre-Existing Condition Insurance Plan Program (Direct)
                  
                  1
                  
               
               
                  0002
                  Administration
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  1
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1
                  2
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  166
                  173
                  397
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  226
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  174
                  399
                  397
               
               
                  1930
                  Total budgetary resources available
                  174
                  399
                  397
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  173
                  397
                  397
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  250
                  230
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1
                  2
                  
               
               
                  3020
                  Outlays (gross)
                  â13
                  â6
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  â226
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  230
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  250
                  230
                  
               
               
                  3200
                  Obligated balance, end of year
                  230
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  13
                  6
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  13
                  6
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 Patient Protection and Affordable Care Act (P.L.
            111â148). The PCIP program ended in FY 2014 as new insurance options became available to the enrolled population, and outlays
            reflected in subsequent fiscal years reflect program close out and claims run out costs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  2
                  
               
               
                  
                     
                  
               
            
         
      
         Early Retiree Reinsurance Program                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Administration
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  13
                  26
                  25
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  14
                  
                  
               
               
                  1900
                  Budget authority (total)
                  14
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  27
                  26
                  25
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  26
                  25
                  24
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  13
                  11
                  5
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1
                  1
                  1
               
               
                  3020
                  Outlays (gross)
                  â3
                  â7
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  11
                  5
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  13
                  11
                  5
               
               
                  3200
                  Obligated balance, end of year
                  11
                  5
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  14
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  3
                  7
                  6
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â14
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â11
                  7
                  6
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and 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 sunset on January 1, 2014, and is no longer providing reimbursements to plan sponsors.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Affordable Insurance Exchange Grants                                                                                     
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Planning and establishment grants
                  449
                  
                  
               
               
                  0002
                  Administration
                  21
                  30
                  32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  470
                  30
                  32
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  508
                  32
                  32
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â38
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  470
                  30
                  32
               
               
                  1930
                  Total budgetary resources available
                  470
                  30
                  32
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,976
                  1,006
                  324
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  470
                  30
                  32
               
               
                  3011
                  Obligations incurred, expired accounts
                  60
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,372
                  â712
                  â319
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â128
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,006
                  324
                  37
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,976
                  1,006
                  324
               
               
                  3200
                  Obligated balance, end of year
                  1,006
                  324
                  37
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  470
                  30
                  32
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  95
                  9
                  10
               
               
                  4101
                  Outlays from mandatory balances
                  1,277
                  703
                  309
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,372
                  712
                  319
               
               
                  4180
                  Budget authority, net (total)
                  470
                  30
                  32
               
               
                  4190
                  Outlays, net (total)
                  1,372
                  712
                  319
               
               
                  
                     
                  
               
            
         
      
      
         This program provides funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
            Marketplaces. The Marketplaces facilitate the purchase of qualified health plans in the individual market and allow small
            businesses to offer qualified health plans to their employees through the Small Business Health Options Program (SHOP). 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. The
            final round of grants was awarded to States in December 2014.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  6
                  7
                  7
               
               
                  25.2
                  Other services from non-Federal sources
                  15
                  23
                  25
               
               
                  41.0
                  Grants, subsidies, and contributions
                  449
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  470
                  30
                  32
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  49
                  50
                  50
               
               
                  
                     
                  
               
            
         
      
         Risk Adjustment Program Payments                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  174
                  262
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Receipts, Risk Adjustment Program
                  2,375
                  3,858
                  4,639
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  2,375
                  4,032
                  4,901
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Risk Adjustment Program Payments
                  â2,375
                  â3,858
                  â4,639
               
               
                  2103
                  Risk Adjustment Program Payments
                  
                  â174
                  â262
               
               
                  2132
                  Risk Adjustment Program Payments
                  174
                  262
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â2,201
                  â3,770
                  â4,901
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â2,201
                  â3,770
                  â4,901
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  174
                  262
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Risk Adjustment Program Payments (Direct)
                  2,201
                  3,646
                  4,901
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  2,201
                  3,646
                  4,901
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  124
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  2,375
                  3,858
                  4,639
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  174
                  262
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â174
                  â262
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  2,201
                  3,770
                  4,901
               
               
                  1930
                  Total budgetary resources available
                  2,201
                  3,770
                  5,025
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  124
                  124
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  442
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,201
                  3,646
                  4,901
               
               
                  3020
                  Outlays (gross)
                  â1,759
                  â4,088
                  â4,560
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  442
                  
                  341
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  442
                  
               
               
                  3200
                  Obligated balance, end of year
                  442
                  
                  341
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,201
                  3,770
                  4,901
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,759
                  3,646
                  4,437
               
               
                  4101
                  Outlays from mandatory balances
                  
                  442
                  123
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,759
                  4,088
                  4,560
               
               
                  4180
                  Budget authority, net (total)
                  2,201
                  3,770
                  4,901
               
               
                  4190
                  Outlays, net (total)
                  1,759
                  4,088
                  4,560
               
               
                  
                     
                  
               
            
         
      
      
         Section 1343 of the Patient Protection and 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. Risk adjustment charges and
            payments were made for the first time in FY 2015 to reflect program year 2014.
         
      
         Transitional Reinsurance Program                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  649
                  443
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Contributions, Transitional Reinsurance Program
                  8,898
                  6,521
                  4,335
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  8,898
                  7,170
                  4,778
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Transitional Reinsurance Program
                  â8,898
                  â6,521
                  â4,335
               
               
                  2103
                  Transitional Reinsurance Program
                  
                  â649
                  â443
               
               
                  2132
                  Transitional Reinsurance Program
                  649
                  443
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â8,249
                  â6,727
                  â4,778
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â8,249
                  â6,727
                  â4,778
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  649
                  443
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Transitional reinsurance payments
                  7,308
                  7,493
                  4,551
               
               
                  0002
                  Administrative expenses
                  
                  
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  7,308
                  7,493
                  4,557
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  941
                  175
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  8,898
                  6,521
                  4,335
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  649
                  443
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â649
                  â443
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  8,249
                  6,727
                  4,778
               
               
                  1930
                  Total budgetary resources available
                  8,249
                  7,668
                  4,953
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  941
                  175
                  396
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  34
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7,308
                  7,493
                  4,557
               
               
                  3020
                  Outlays (gross)
                  â7,308
                  â7,459
                  â4,554
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  34
                  37
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  34
               
               
                  3200
                  Obligated balance, end of year
                  
                  34
                  37
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8,249
                  6,727
                  4,778
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7,308
                  6,518
                  4,345
               
               
                  4101
                  Outlays from mandatory balances
                  
                  941
                  209
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  7,308
                  7,459
                  4,554
               
               
                  4180
                  Budget authority, net (total)
                  8,249
                  6,727
                  4,778
               
               
                  4190
                  Outlays, net (total)
                  7,308
                  7,459
                  4,554
               
               
                  
                     
                  
               
            
         
      
      
         Section 1341 of the Patient Protection and 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 contributing entities a per enrollee fee to fund the reinsurance
            program, 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. Reinsurance collections and payments were made for the first time in FY 2015 to reflect program year 2014.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions - Transitional Reinsurance
                  7,308
                  7,493
                  4,551
               
               
                  41.0
                  Grants, subsidies, and contributions - Administration
                  
                  
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  7,308
                  7,493
                  4,557
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0701
                  Direct loan subsidy
                  42
                  
                  
               
               
                  0703
                  Subsidy for modifications of direct loans
                  1
                  
                  
               
               
                  0705
                  Reestimates of direct loan subsidy
                  
                  89
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  
                  4
                  
               
               
                  0709
                  Administrative expenses
                  10
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  53
                  95
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  56
                  3
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  92
                  
               
               
                  1930
                  Total budgetary resources available
                  56
                  95
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  154
                  69
                  4
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  53
                  95
                  
               
               
                  3020
                  Outlays (gross)
                  â138
                  â160
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  69
                  4
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  154
                  69
                  4
               
               
                  3200
                  Obligated balance, end of year
                  69
                  4
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  92
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  92
                  
               
               
                  4101
                  Outlays from mandatory balances
                  138
                  68
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  138
                  160
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  92
                  
               
               
                  4190
                  Outlays, net (total)
                  138
                  160
                  2
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan levels supportable by subsidy budget authority:
               
               
                  115002
                  Solvency Loans
                  88
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  115999
                  Total direct loan levels
                  88
                  
                  
               
               
                  
                  Direct loan subsidy (in percent):
               
               
                  132002
                  Solvency Loans
                  48.22
                  0.00
                  0.00
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  132999
                  Weighted average subsidy rate
                  48.22
                  0.00
                  0.00
               
               
                  
                  Direct loan subsidy budget authority:
               
               
                  133002
                  Solvency Loans
                  42
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  133999
                  Total subsidy budget authority
                  42
                  
                  
               
               
                  
                  Direct loan subsidy outlays:
               
               
                  134001
                  Startup Loans
                  3
                  
                  
               
               
                  134002
                  Solvency Loans
                  126
                  61
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  134999
                  Total subsidy outlays
                  129
                  61
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135001
                  Startup Loans
                  â1
                  4
                  
               
               
                  135002
                  Solvency Loans
                  
                  88
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  â1
                  92
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  9
                  7
                  2
               
               
                  
                     
                  
               
            
         
      
      
         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 Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  
                  
               
               
                  23.1
                  Rental payments to GSA
                  2
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  6
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  43
                  93
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  53
                  95
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  15
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Account                                                                      
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  7
                  7
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Consumer Operated and Oriented Plan Direct Loan Program, Negative Subsidies
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  7
                  7
                  7
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0703
                  Subsidy for modifications of direct loans
                  3
                  
                  
               
               
                  0705
                  Reestimates of direct loan subsidy
                  23
                  430
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  2
                  46
                  
               
               
                  0709
                  Administrative expenses
                  
                  6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  28
                  482
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  9
                  7
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  26
                  476
                  
               
               
                  1930
                  Total budgetary resources available
                  35
                  483
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  282
                  98
                  2
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  28
                  482
                  
               
               
                  3020
                  Outlays (gross)
                  â212
                  â578
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  98
                  2
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  282
                  98
                  2
               
               
                  3200
                  Obligated balance, end of year
                  98
                  2
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  26
                  476
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  26
                  476
                  
               
               
                  4101
                  Outlays from mandatory balances
                  186
                  102
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  212
                  578
                  1
               
               
                  4180
                  Budget authority, net (total)
                  26
                  476
                  
               
               
                  4190
                  Outlays, net (total)
                  212
                  578
                  1
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan subsidy outlays:
               
               
                  134002
                  Startup Loans
                  3
                  
                  
               
               
                  134003
                  Solvency  Loans
                  182
                  97
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  134999
                  Total subsidy outlays
                  185
                  97
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  â5
                  57
                  
               
               
                  135003
                  Solvency  Loans
                  26
                  416
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  21
                  473
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  
                  4
                  1
               
               
                  
                     
                  
               
            
         
      
      
         Section 1322 of the Patient Protection and 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.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  3
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  28
                  476
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  28
                  482
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  15
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  24
                  35
                  34
               
               
                  0741
                  Modification savings
                  6
                  
                  
               
               
                  0742
                  Downward reestimate paid to receipt account
                  5
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  35
                  38
                  34
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  2
                  38
                  34
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  217
                  600
                  26
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â184
                  â97
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â503
                  â26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  33
                  
                  
               
               
                  1900
                  Budget authority (total)
                  35
                  38
                  34
               
               
                  1930
                  Total budgetary resources available
                  35
                  38
                  34
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  642
                  225
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  35
                  38
                  34
               
               
                  3020
                  Outlays (gross)
                  â452
                  â263
                  â34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  225
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â281
                  â97
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  184
                  97
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â97
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  361
                  128
                  
               
               
                  3200
                  Obligated balance, end of year
                  128
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  35
                  38
                  34
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  452
                  263
                  34
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â212
                  â574
                  
               
               
                  4122
                  Interest on uninvested funds
                  â5
                  â5
                  â5
               
               
                  4123
                  Non-Federal sources
                  
                  â21
                  â21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â217
                  â600
                  â26
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  184
                  97
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  2
                  â465
                  8
               
               
                  4170
                  Outlays, net (mandatory)
                  235
                  â337
                  8
               
               
                  4180
                  Budget authority, net (total)
                  2
                  â465
                  8
               
               
                  4190
                  Outlays, net (total)
                  235
                  â337
                  8
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  1,315
                  1,727
                  1,931
               
               
                  1231
                  Disbursements: Direct loan disbursements
                  417
                  225
                  
               
               
                  1251
                  Repayments: Repayments and prepayments
                  
                  â21
                  â21
               
               
                  1263
                  Write-offs for default: Direct loans
                  â5
                  
                  â19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,727
                  1,931
                  1,891
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2014 actual
                  2015 actual
               
               
                  
                     
                  
               
               
                  
                  Group heading
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  99
                  68
               
               
                  
                  Investments in US securities:
               
               
                  1106
                  Receivables, net
                  6
                  79
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  1,315
                  1,727
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â570
                  â813
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  745
                  914
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  850
                  1,061
               
               
                  
                  LIABILITIES:
               
               
                  2103
                  Federal liabilities: Debt
                  850
                  1,061
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  850
                  1,061
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing Account                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0710
                  Direct loan obligations
                  87
                  
                  
               
               
                  0713
                  Payment of interest to Treasury
                  6
                  9
                  9
               
               
                  0741
                  Modification savings
                  1
                  
                  
               
               
                  0742
                  Downward reestimate paid to receipt account
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  95
                  9
                  9
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  49
                  5
                  8
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  133
                  158
                  4
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â87
                  â61
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â93
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  46
                  4
                  1
               
               
                  1900
                  Budget authority (total)
                  95
                  9
                  9
               
               
                  1930
                  Total budgetary resources available
                  95
                  9
                  9
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  355
                  148
                  2
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  95
                  9
                  9
               
               
                  3020
                  Outlays (gross)
                  â302
                  â155
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  148
                  2
                  3
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â149
                  â62
                  â1
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  87
                  61
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â62
                  â1
                  â1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  206
                  86
                  1
               
               
                  3200
                  Obligated balance, end of year
                  86
                  1
                  2
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  95
                  9
                  9
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  302
                  155
                  8
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â130
                  â154
                  
               
               
                  4122
                  Interest on uninvested funds
                  â3
                  â1
                  â1
               
               
                  4123
                  Non-Federal sources
                  
                  â3
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â133
                  â158
                  â4
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  87
                  61
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  49
                  â88
                  5
               
               
                  4170
                  Outlays, net (mandatory)
                  169
                  â3
                  4
               
               
                  4180
                  Budget authority, net (total)
                  49
                  â88
                  5
               
               
                  4190
                  Outlays, net (total)
                  169
                  â3
                  4
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Position with respect to appropriations act limitation on obligations:
               
               
                  1121
                  Limitation available from carry-forward
                  87
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1150
                  Total direct loan obligations
                  87
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  49
                  343
                  486
               
               
                  1231
                  Disbursements: Direct loan disbursements
                  294
                  146
                  
               
               
                  1251
                  Repayments: Repayments and prepayments
                  
                  â3
                  â3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  343
                  486
                  483
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2014 actual
                  2015 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  6
                  44
               
               
                  1206
                  Non-Federal assets: Receivables, net
                  
                  16
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  49
                  343
               
               
                  1402
                  Interest receivable
                  1
                  1
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â19
                  â153
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  31
                  191
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  37
                  251
               
               
                  
                  LIABILITIES:
               
               
                  2104
                  Federal liabilities: Resources payable to Treasury
                  37
                  244
               
               
                  2207
                  Non-Federal liabilities: Other
                  
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total liabilities
                  37
                  251
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  37
                  251
               
               
                  
                     
                  
               
            
         
      
      Trust Funds  
         Federal Hospital Insurance Trust Fund                                                                                    
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  171,674
                  161,965
                  156,831
               
               
                  0198
                  Adjustment - account receivable in cancelling annual account
                  71
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  171,745
                  161,965
                  156,831
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  215,403
                  226,589
                  234,557
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  565
                  614
                  625
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  18,221
                  16,335
                  18,111
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  512
                  734
                  775
               
               
                  1130
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  3
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  321
                  326
                  357
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  4,852
                  6,000
                  6,050
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  7
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,277
                  3,461
                  3,649
               
               
                  1140
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,450
                  3,619
                  3,702
               
               
                  1140
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  623
                  660
                  680
               
               
                  1140
                  FHI Trust Fund, Interest Received by Trust Funds
                  8,594
                  8,038
                  7,986
               
               
                  1140
                  FHI Trust Fund, Taxation on OASDI Benefits
                  20,208
                  23,208
                  25,987
               
               
                  1140
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  129
                  130
                  141
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  57
                  550
                  590
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  46
                  35
                  36
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  15
                  29
                  30
               
               
                  1140
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  30
                  30
                  35
               
               
                  1140
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  900
                  1,387
                  1,149
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  277,213
                  291,749
                  304,464
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  8
                  506
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â33
               
               
                  1240
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  7
                  74
               
               
                  1240
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  15
                  549
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  277,213
                  291,764
                  305,013
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  448,958
                  453,729
                  461,844
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â3,211
                  â2,662
                  â2,567
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â272,149
                  â287,128
                  â299,848
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â672
                  â681
                  â725
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,325
                  â744
                  â1,149
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  
                  
                  825
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â9,696
                  â5,733
                  â2,028
               
               
                  2132
                  Federal Hospital Insurance Trust Fund
                  8
                  
                  
               
               
                  2132
                  Health Care Fraud and Abuse Control Account
                  52
                  50
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â286,993
                  â296,898
                  â305,492
               
               
                  
                  Proposed:
               
               
                  2203
                  Federal Hospital Insurance Trust Fund
                  
                  
                  2,961
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â286,993
                  â296,898
                  â302,531
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  161,965
                  156,831
                  159,313
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  277,368
                  290,051
                  300,069
               
               
                  0002
                  HIT Incentive Payments
                  3,196
                  2,040
                  1,005
               
               
                  0003
                  Administration, HI
                  3,780
                  2,985
                  2,906
               
               
                  0004
                  Quality improvement organizations, HI
                  730
                  447
                  463
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  285,074
                  295,523
                  304,443
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  285,074
                  295,523
                  304,443
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  13
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  3,211
                  2,662
                  2,567
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  272,149
                  287,128
                  299,848
               
               
                  1203
                  Appropriation (previously unavailable)
                  9,696
                  5,733
                  2,028
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  281,837
                  292,861
                  301,876
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  13
                  
                  
               
               
                  1900
                  Budget authority (total)
                  285,061
                  295,523
                  304,443
               
               
                  1930
                  Total budgetary resources available
                  285,074
                  295,523
                  304,443
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  29,103
                  32,217
                  32,000
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  285,074
                  295,523
                  304,443
               
               
                  3020
                  Outlays (gross)
                  â281,947
                  â295,740
                  â304,643
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  32,217
                  32,000
                  31,800
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  29,103
                  32,217
                  32,000
               
               
                  3200
                  Obligated balance, end of year
                  32,217
                  32,000
                  31,800
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,211
                  2,662
                  2,567
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,734
                  1,952
                  1,959
               
               
                  4011
                  Outlays from discretionary balances
                  733
                  853
                  787
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,467
                  2,805
                  2,746
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  281,850
                  292,861
                  301,876
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  250,291
                  264,096
                  272,502
               
               
                  4101
                  Outlays from mandatory balances
                  28,189
                  28,839
                  29,395
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  278,480
                  292,935
                  301,897
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â13
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  285,048
                  295,523
                  304,443
               
               
                  4190
                  Outlays, net (total)
                  281,934
                  295,740
                  304,643
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  202,207
                  195,458
                  189,724
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  195,458
                  189,724
                  187,696
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  285,048
                  295,523
                  304,443
               
               
                  
                  Outlays
                  281,934
                  295,740
                  304,643
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â2,961
               
               
                  
                  Outlays
                  
                  
                  â2,961
               
               
                  Total:
               
               
                  
                  Budget Authority
                  285,048
                  295,523
                  301,482
               
               
                  
                  Outlays
                  281,934
                  295,740
                  301,682
               
               
                  
                     
                  
               
            
         
      
      
         The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
            disabled people.
         
         In addition, the Budget includes a package of proposals that improve Medicare's sustainability by encouraging delivery system
            reform; promoting high-quality, efficient care; increasing value in provider payments; and encouraging beneficiaries to seek
            high-value services. The status of the trust fund is as follows.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  202,362
                  196,064
                  190,147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  202,362
                  196,064
                  190,147
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  215,403
                  226,589
                  234,557
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  565
                  614
                  625
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  18,221
                  16,335
                  18,111
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  512
                  734
                  775
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  321
                  326
                  357
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  4,852
                  6,000
                  6,050
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  7
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,277
                  3,461
                  3,649
               
               
                  1130
                  Federal Hospital Insurance Trust Fund
                  13
                  
                  
               
               
                  1150
                  FHI Trust Fund, Interest Received by Trust Funds
                  8,594
                  8,038
                  7,986
               
               
                  1150
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  3
                  2
                  2
               
               
                  1150
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  30
                  30
                  35
               
               
                  1160
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,450
                  3,619
                  3,702
               
               
                  1160
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  623
                  660
                  680
               
               
                  1160
                  FHI Trust Fund, Taxation on OASDI Benefits
                  20,208
                  23,208
                  25,987
               
               
                  1160
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  129
                  130
                  141
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  57
                  550
                  590
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  46
                  35
                  36
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  15
                  29
                  30
               
               
                  1160
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  900
                  1,387
                  1,149
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  277,226
                  291,749
                  304,464
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  8
                  506
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â33
               
               
                  1230
                  Federal Hospital Insurance Trust Fund
                  
                  
                  5
               
               
                  1250
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  7
                  74
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  FHI Trust Fund, Transfers from General Fund (Net Investment Tax)
                  
                  
                  
               
               
                  1260
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  15
                  554
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  277,226
                  291,764
                  305,018
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Hospital Insurance Trust Fund [009â38â8005â0]
                  â281,947
                  â295,740
                  â304,643
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [009â38â8393â0]
                  â1,575
                  â1,941
                  â1,905
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [009â38â8393â7]
                  
                  
                  825
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â283,522
                  â297,681
                  â305,723
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Hospital Insurance Trust Fund
                  
                  
                  2,956
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  2,956
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â283,522
                  â297,681
                  â302,767
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  â14,923
                  â13,994
                  â5,846
               
               
                  3120
                  Interest
                  8,627
                  8,077
                  8,097
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â6,296
                  â5,917
                  2,251
               
               
                  3298
                  Rounding adjustment
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  â2
                  
                  
               
               
                  
                  Unexpended balance, end of year::
               
               
                  4100
                  Uninvested balance (net), end of year
                  606
                  423
                  4,702
               
               
                  4200
                  Federal Hospital Insurance Trust Fund
                  195,458
                  189,724
                  187,696
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  196,064
                  190,147
                  192,398
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activities
                  730
                  447
                  463
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  280,564
                  292,091
                  301,074
               
               
                  94.0
                  Financial transfers
                  3,780
                  2,985
                  2,906
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  285,074
                  295,523
                  304,443
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â4â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â3,055
               
               
                  0003
                  Administration, HI
                  
                  
                  94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â2,961
               
               
                  0801
                  Reimbursable program activity
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  â2,956
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  â2,961
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  5
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â2,956
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â2,956
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â2,956
               
               
                  3020
                  Outlays (gross)
                  
                  
                  2,956
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â2,956
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â2,956
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  
                  â5
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â2,961
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â2,961
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â4â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â3,055
               
               
                  94.0
                  Financial transfers
                  
                  
                  94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  â2,961
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  â2,956
               
               
                  
                     
                  
               
            
         
      
         health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management, [$681,000,000] $725,000,000, to remain available through September 30, [2017] 2018, 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 [$486,120,000] $486,936,000 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 [$67,200,000] $121,824,000 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)(C) of such Act, [of which $67,200,000 shall be for the Medicaid and Children's Health Insurance Program ("CHIP") program integrity activities,] and of which [$60,480,000] $116,240,000 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 [2016] 2017 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: Provided further, That of the amount provided under this heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii) of
         the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and [$370,000,000] $414,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the Secretary shall support the [full cost of the] Senior Medicare Patrol program to combat health care fraud and abuse from the funds provided to this account. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare integrity program
                  860
                  866
                  882
               
               
                  0002
                  FBI fraud and abuse control
                  142
                  130
                  141
               
               
                  0003
                  Other fraud and abuse control
                  316
                  282
                  301
               
               
                  0005
                  Undistributed Savings, HCFAC and SSA
                  
                  â585
                  â175
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  1,318
                  693
                  1,149
               
               
                  0101
                  CMS discretionary
                  385
                  553
                  487
               
               
                  0102
                  Other discretionary
                  134
                  128
                  238
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total Discretionary
                  519
                  681
                  725
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,837
                  1,374
                  1,874
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  166
                  322
                  323
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  29
                  188
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  214
                  322
                  323
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  672
                  681
                  725
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1,325
                  744
                  1,149
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â52
                  â50
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,273
                  694
                  1,149
               
               
                  1900
                  Budget authority (total)
                  1,945
                  1,375
                  1,874
               
               
                  1930
                  Total budgetary resources available
                  2,159
                  1,697
                  2,197
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  322
                  323
                  323
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1952
                  Expired unobligated balance, start of year
                  36
                  17
                  44
               
               
                  1953
                  Expired unobligated balance, end of year
                  17
                  44
                  44
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,312
                  1,499
                  932
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,837
                  1,374
                  1,874
               
               
                  3020
                  Outlays (gross)
                  â1,575
                  â1,941
                  â1,905
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â48
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,499
                  932
                  901
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,312
                  1,499
                  932
               
               
                  3200
                  Obligated balance, end of year
                  1,499
                  932
                  901
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  672
                  681
                  725
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  119
                  681
                  725
               
               
                  4011
                  Outlays from discretionary balances
                  200
                  188
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  319
                  869
                  725
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,273
                  694
                  1,149
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  287
                  328
                  734
               
               
                  4101
                  Outlays from mandatory balances
                  969
                  744
                  446
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,256
                  1,072
                  1,180
               
               
                  4180
                  Budget authority, net (total)
                  1,945
                  1,375
                  1,874
               
               
                  4190
                  Outlays, net (total)
                  1,575
                  1,941
                  1,905
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,945
                  1,375
                  1,874
               
               
                  
                  Outlays
                  1,575
                  1,941
                  1,905
               
               
                  Amounts included in the adjusted baseline:
               
               
                  
                  Budget Authority
                  
                  
                  â825
               
               
                  
                  Outlays
                  
                  
                  â825
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,945
                  1,375
                  1,049
               
               
                  
                  Outlays
                  1,575
                  1,941
                  1,080
               
               
                  
                     
                  
               
            
         
      
      
         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 075â8393â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent (CMS)
                  47
                  73
                  73
               
               
                  12.1
                  Civilian personnel benefits (CMS)
                  14
                  20
                  20
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  13
                  20
                  20
               
               
                  25.2
                  Other services (CMS/Medicaid)
                  40
                  56
                  44
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  157
                  119
                  179
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  256
                  255
                  322
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/AoA)
                  9
                  9
                  10
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OGC)
                  10
                  10
                  11
               
               
                  25.3
                  Other goods and services from Federal sources (HHS/CMS)
                  14
                  14
                  14
               
               
                  25.3
                  Other goods and services from Government accounts (HHS/FDA)
                  3
                  3
                  3
               
               
                  25.6
                  Medical care  (CMS)
                  1,132
                  1,250
                  1,212
               
               
                  92.0
                  Undistributed
                  
                  â585
                  â175
               
               
                  94.0
                  Financial transfers (FBI)
                  142
                  130
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,837
                  1,374
                  1,874
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  425
                  577
                  593
               
               
                  
                     
                  
               
            
         
      
         Health Care Fraud and Abuse Control Account                                                                              
            
         
         (Amounts included in the adjusted baseline)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â7â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â825
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â825
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â825
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â825
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  825
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  825
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  825
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â825
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â825
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â825
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â825
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  35,073
                  39,267
                  50,191
               
               
                  0198
                  Adjustment - expired accounts, receipts withdrawn
                  491
                  
                  
               
               
                  0198
                  Prior year budgetary adjustments
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  35,557
                  39,267
                  50,191
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  2,991
                  2,969
                  3,980
               
               
                  1130
                  Other Proprietary Interest from the Public, FSMI Fund
                  12
                  3
                  3
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  3,815
                  4,300
                  5,310
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  8,797
                  9,569
                  10,688
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  358
                  367
                  403
               
               
                  1130
                  Medicare Refunds, SMI
                  5,666
                  5,500
                  5,550
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  6
                  8
                  8
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  56,997
                  61,110
                  67,535
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  10,122
                  11,011
                  11,647
               
               
                  1140
                  Federal Contributions, FSMI Fund
                  195,835
                  237,231
                  214,944
               
               
                  1140
                  Interest Received by Trust Fund, FSMI Fund
                  2,471
                  1,926
                  2,093
               
               
                  1140
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  3
                  3
               
               
                  1140
                  Interest, Medicare Prescription Drug Account, FSMI
                  11
                  11
                  14
               
               
                  1140
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  439
                  308
                  325
               
               
                  1140
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  67,210
                  76,190
                  82,512
               
               
                  1140
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  354,731
                  410,507
                  405,016
               
               
                  
                  Proposed:
               
               
                  1230
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  â130
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â90
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â47
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â15
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  
                  
                  â179
               
               
                  1240
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â640
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â1,101
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  354,731
                  410,507
                  403,915
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  390,288
                  449,774
                  454,106
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â2,262
                  â2,959
                  â3,413
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â271,952
                  â311,575
                  â302,754
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â408
                  â303
                  â314
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â80,155
                  â95,670
                  â98,535
               
               
                  2103
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â9,570
               
               
                  2134
                  Federal Supplementary Medical Insurance Trust Fund
                  3,756
                  10,924
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â351,021
                  â399,583
                  â414,586
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  819
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â578
               
               
                  2201
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  860
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â799
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  799
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  
                  1,101
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â351,021
                  â399,583
                  â413,485
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  39,267
                  50,191
                  40,621
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  265,320
                  298,683
                  310,577
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  749
                  869
                  954
               
               
                  0003
                  HIT Incentive Payments
                  1,862
                  760
                  440
               
               
                  0004
                  Administration, SMI
                  2,355
                  3,186
                  3,650
               
               
                  0005
                  Quality Improvement Organizations, SMI
                  182
                  112
                  116
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  270,468
                  303,610
                  315,737
               
               
                  0801
                  Federal Supplementary Medical Insurance Trust Fund (Reimbursable)
                  11,172
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  281,640
                  303,610
                  315,737
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  2,262
                  2,959
                  3,413
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  271,952
                  311,575
                  302,754
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  9,570
               
               
                  1234
                  Appropriations precluded from obligation
                  â3,756
                  â10,924
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  268,196
                  300,651
                  312,324
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  10
                  
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  11,172
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  11,182
                  
                  
               
               
                  1900
                  Budget authority (total)
                  281,640
                  303,610
                  315,737
               
               
                  1930
                  Total budgetary resources available
                  281,640
                  303,610
                  315,737
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  22,625
                  23,290
                  23,585
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  281,640
                  303,610
                  315,737
               
               
                  3020
                  Outlays (gross)
                  â280,975
                  â303,315
                  â315,340
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  23,290
                  23,585
                  23,982
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â11,172
                  
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  11,172
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â11,172
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â11,172
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  22,625
                  23,290
                  23,585
               
               
                  3200
                  Obligated balance, end of year
                  12,118
                  23,585
                  23,982
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,262
                  2,959
                  3,413
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,700
                  1,956
                  2,216
               
               
                  4011
                  Outlays from discretionary balances
                  337
                  641
                  778
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,037
                  2,597
                  2,994
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  279,378
                  300,651
                  312,324
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  258,444
                  279,811
                  285,206
               
               
                  4101
                  Outlays from mandatory balances
                  20,494
                  20,907
                  27,140
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  278,938
                  300,718
                  312,346
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â10
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â11,172
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  268,196
                  300,651
                  312,324
               
               
                  4170
                  Outlays, net (mandatory)
                  278,928
                  300,718
                  312,346
               
               
                  4180
                  Budget authority, net (total)
                  270,458
                  303,610
                  315,737
               
               
                  4190
                  Outlays, net (total)
                  280,965
                  303,315
                  315,340
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  68,391
                  66,128
                  78,344
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  66,128
                  78,344
                  68,997
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  270,458
                  303,610
                  315,737
               
               
                  
                  Outlays
                  280,965
                  303,315
                  315,340
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â20
               
               
                  
                  Outlays
                  
                  
                  â20
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â221
               
               
                  
                  Outlays
                  
                  
                  â221
               
               
                  Total:
               
               
                  
                  Budget Authority
                  270,458
                  303,610
                  315,496
               
               
                  
                  Outlays
                  280,965
                  303,315
                  315,099
               
               
                  
                     
                  
               
            
         
      
      
         The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician
            care 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 Budget includes a package of proposals that strengthen Medicare by more closely aligning payments with the costs of providing
            care, encouraging health care providers to deliver better care and better outcomes for their patients, and improving access
            to care for beneficiaries.  The Budget also makes structural changes that will reduce Federal subsidies to high income beneficiaries
            and create incentives for beneficiaries to seek high value services. The status of the trust fund is as follows.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  71,328
                  69,122
                  80,344
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  71,328
                  69,122
                  80,344
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  2,991
                  2,969
                  3,980
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  3,815
                  4,300
                  5,310
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  8,797
                  9,569
                  10,688
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  358
                  367
                  403
               
               
                  1130
                  Medicare Refunds, SMI
                  5,666
                  5,500
                  5,550
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  6
                  8
                  8
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  56,997
                  61,110
                  67,535
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  10,122
                  11,011
                  11,647
               
               
                  1130
                  Federal Supplementary Medical Insurance Trust Fund
                  10
                  
                  
               
               
                  1130
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  6
                  
                  
               
               
                  1150
                  Interest Received by Trust Fund, FSMI Fund
                  2,471
                  1,926
                  2,093
               
               
                  1150
                  Other Proprietary Interest from the Public, FSMI Fund
                  12
                  3
                  3
               
               
                  1150
                  Interest, Medicare Prescription Drug Account, FSMI
                  11
                  11
                  14
               
               
                  1160
                  Federal Contributions, FSMI Fund
                  195,835
                  237,231
                  214,944
               
               
                  1160
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  3
                  3
               
               
                  1160
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  439
                  308
                  325
               
               
                  1160
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  67,210
                  76,190
                  82,512
               
               
                  1160
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  354,747
                  410,507
                  405,016
               
               
                  
                  Proposed:
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  â130
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â90
               
               
                  1230
                  Low Income Subsidy Part D Rebate
                  
                  
                  
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â47
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â15
               
               
                  1230
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  4
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  Federal Contributions, FSMI Fund
                  
                  
                  â179
               
               
                  1260
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  â640
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â1,097
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  354,747
                  410,507
                  403,919
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Supplementary Medical Insurance Trust Fund [009â38â8004â0]
                  â280,975
                  â303,315
                  â315,340
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009â38â8308â0]
                  â75,978
                  â95,970
                  â98,852
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â356,953
                  â399,285
                  â414,192
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  20
               
               
                  2200
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  217
               
               
                  2200
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  860
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  1,097
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â356,953
                  â399,285
                  â413,095
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  â4,700
                  9,282
                  â11,286
               
               
                  3120
                  Interest
                  2,494
                  1,940
                  2,110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â2,206
                  11,222
                  â9,176
               
               
                  
                  Unexpended balance, end of year::
               
               
                  4100
                  Uninvested balance (net), end of year
                  2,994
                  2,000
                  2,171
               
               
                  4200
                  Federal Supplementary Medical Insurance Trust Fund
                  66,128
                  78,344
                  68,997
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  69,122
                  80,344
                  71,168
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activity
                  182
                  112
                  116
               
               
                  42.0
                  Insurance claims and indemnities
                  267,931
                  300,312
                  311,971
               
               
                  94.0
                  Financial transfers
                  2,355
                  3,186
                  3,650
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  270,468
                  303,610
                  315,737
               
               
                  99.0
                  Reimbursable obligations
                  11,172
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  281,640
                  303,610
                  315,737
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â2â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  
                  â20
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â819
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  799
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â20
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â20
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â20
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â20
               
               
                  3020
                  Outlays (gross)
                  
                  
                  20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â20
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â20
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â20
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â20
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â4â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â424
               
               
                  0004
                  Administration, SMI
                  
                  
                  203
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  â221
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  578
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  â799
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â221
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  4
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â217
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â217
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â221
               
               
                  3020
                  Outlays (gross)
                  
                  
                  217
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â4
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â217
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â217
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  
                  
                  â4
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â221
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â221
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â4â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  
                  â424
               
               
                  94.0
                  Financial transfers
                  
                  
                  203
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  â221
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  â221
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  80,145
                  95,659
                  98,524
               
               
                  0002
                  Administrative Costs
                  418
                  314
                  325
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  80,563
                  95,973
                  98,849
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  408
                  303
                  314
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  80,155
                  95,670
                  98,535
               
               
                  1900
                  Budget authority (total)
                  80,563
                  95,973
                  98,849
               
               
                  1930
                  Total budgetary resources available
                  80,563
                  95,973
                  98,849
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1952
                  Expired unobligated balance, start of year
                  179
                  132
                  132
               
               
                  1953
                  Expired unobligated balance, end of year
                  132
                  132
                  132
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  12,967
                  17,554
                  6,385
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  
                  â11,172
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  80,563
                  95,973
                  98,849
               
               
                  3011
                  Obligations incurred, expired accounts
                  21
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â75,978
                  â95,970
                  â98,852
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  17,554
                  6,385
                  6,382
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  12,967
                  6,382
                  6,385
               
               
                  3200
                  Obligated balance, end of year
                  17,554
                  6,385
                  6,382
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  408
                  303
                  314
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  236
                  236
                  248
               
               
                  4011
                  Outlays from discretionary balances
                  276
                  58
                  63
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  512
                  294
                  311
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  â6
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  408
                  303
                  314
               
               
                  4080
                  Outlays, net (discretionary)
                  506
                  294
                  311
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  80,155
                  95,670
                  98,535
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  62,587
                  89,743
                  89,431
               
               
                  4101
                  Outlays from mandatory balances
                  12,879
                  5,933
                  9,110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  75,466
                  95,676
                  98,541
               
               
                  4180
                  Budget authority, net (total)
                  80,563
                  95,973
                  98,849
               
               
                  4190
                  Outlays, net (total)
                  75,972
                  95,970
                  98,852
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  80,563
                  95,973
                  98,849
               
               
                  
                  Outlays
                  75,972
                  95,970
                  98,852
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â860
               
               
                  
                  Outlays
                  
                  
                  â860
               
               
                  Total:
               
               
                  
                  Budget Authority
                  80,563
                  95,973
                  97,989
               
               
                  
                  Outlays
                  75,972
                  95,970
                  97,992
               
               
                  
                     
                  
               
            
         
      
      
         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 and address the rising
            cost of pharmaceuticals.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  418
                  314
                  325
               
               
                  42.0
                  Insurance claims and indemnities
                  80,145
                  95,659
                  98,524
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  80,563
                  95,973
                  98,849
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â4â7â571
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  
                  
                  â860
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  
                  
                  â860
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â860
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â860
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â860
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â860
               
               
                  3020
                  Outlays (gross)
                  
                  
                  860
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â860
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â860
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â860
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â860
               
               
                  
                     
                  
               
            
         
      
         Administration for Children and Families                                                                                 
            
         Federal Funds
         Temporary Assistance for Needy Families                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  16,484
                  16,486
                  16,486
               
               
                  0002
                  Territories - family assistance grants
                  78
                  78
                  78
               
               
                  0006
                  Tribal work programs
                  7
                  8
                  8
               
               
                  0009
                  Healthy marriage and responsible fatherhood grants
                  147
                  148
                  150
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  16,716
                  16,720
                  16,722
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  16,739
                  16,739
                  16,739
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,737
                  16,737
                  16,739
               
               
                  1930
                  Total budgetary resources available
                  16,737
                  16,737
                  16,741
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â21
                  â15
                  â15
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  2
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,250
                  5,939
                  6,266
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  16,716
                  16,720
                  16,722
               
               
                  3020
                  Outlays (gross)
                  â15,942
                  â16,393
                  â16,439
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â85
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  5,939
                  6,266
                  6,549
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  5,250
                  5,939
                  6,266
               
               
                  3200
                  Obligated balance, end of year
                  5,939
                  6,266
                  6,549
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16,737
                  16,737
                  16,739
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  12,784
                  13,042
                  13,043
               
               
                  4101
                  Outlays from mandatory balances
                  3,158
                  3,351
                  3,396
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  15,942
                  16,393
                  16,439
               
               
                  4180
                  Budget authority, net (total)
                  16,737
                  16,737
                  16,739
               
               
                  4190
                  Outlays, net (total)
                  15,942
                  16,393
                  16,439
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  16,737
                  16,737
                  16,739
               
               
                  
                  Outlays
                  15,942
                  16,393
                  16,439
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  760
               
               
                  
                  Outlays
                  
                  
                  593
               
               
                  Total:
               
               
                  
                  Budget Authority
                  16,737
                  16,737
                  17,499
               
               
                  
                  Outlays
                  15,942
                  16,393
                  17,032
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funding for the Temporary Assistance for Needy Families (TANF) 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, 2016 (P.L. 114â113). The Budget includes an $8 billion increase to the TANF block
            grant over five years. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  30
                  30
                  30
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16,683
                  16,686
                  16,686
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  16,716
                  16,720
                  16,722
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  15
                  14
                  19
               
               
                  
                     
                  
               
            
         
      
         Temporary Assistance for Needy Families                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grants
                  
                  
                  747
               
               
                  0002
                  Territories - family assistance grants
                  
                  
                  3
               
               
                  0006
                  Monitoring and Oversight
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  760
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  750
               
               
                  1221
                  Appropriations transferred from other acct [075â1522]
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  760
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  760
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  760
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â593
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  167
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  167
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  760
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  593
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  760
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  593
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  10
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  750
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  760
               
               
                  
                     
                  
               
            
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  685
                  583
                  583
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  685
                  583
                  583
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  81
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  103
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1120
                  Appropriations transferred to other acct [075â1553]
                  
                  
                  â15
               
               
                  1120
                  Appropriations transferred to other acct [013â0401]
                  
                  
                  â10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  â25
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  608
                  608
                  608
               
               
                  1220
                  Appropriations transferred to other accts [075â1553]
                  â15
                  â15
                  
               
               
                  1220
                  Appropriations transferred to other accts [013â0401]
                  â10
                  â10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  583
                  583
                  608
               
               
                  1900
                  Budget authority (total)
                  583
                  583
                  583
               
               
                  1930
                  Total budgetary resources available
                  686
                  584
                  584
               
               
                  
                  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
                  131
                  60
                  87
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  685
                  583
                  583
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â730
                  â556
                  â593
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â22
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  60
                  87
                  77
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  131
                  60
                  87
               
               
                  3200
                  Obligated balance, end of year
                  60
                  87
                  77
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â25
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â22
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  583
                  583
                  608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  564
                  525
                  547
               
               
                  4101
                  Outlays from mandatory balances
                  166
                  31
                  68
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  730
                  556
                  615
               
               
                  4180
                  Budget authority, net (total)
                  583
                  583
                  583
               
               
                  4190
                  Outlays, net (total)
                  730
                  556
                  593
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  583
                  583
                  583
               
               
                  
                  Outlays
                  730
                  556
                  593
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â10
               
               
                  
                  Outlays
                  
                  
                  â9
               
               
                  Total:
               
               
                  
                  Budget Authority
                  583
                  583
                  573
               
               
                  
                  Outlays
                  730
                  556
                  584
               
               
                  
                     
                  
               
            
         
      
      
         This account provides a funding reserve to assist states that meet certain criteria intended to reflect economic distress
            and was established by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended
            by the Deficit Reduction Act of 2005 (P.L. 109â171). The Consolidated and Further Continuing Appropriations Act, 2015 (P.L.
            113â235) most recently temporarily reauthorized this account through FY 2017. In FY 2017, the Budget includes a general provision
            to transfer $15 million from the Contingency Fund to Welfare Research, and to transfer $10 million to support the Census Survey
            of Income and Program Participation, consistent with the FY 2016 appropriations funding. The Budget also includes a proposal
            to redirect $10 million for TANF program improvements, including technical assistance for state programs, research, and evaluation.
            The Budget also re-purposes $473 million for the Pathways to Jobs initiative and $100 million for Two-Generation Demonstration
            projects.
         
      
         Contingency Fund                                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â4â1â609
                  2015 actual
                  2016 est.
                  2017 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:
               
               
                  1220
                  Appropriations transferred to other acct [075â1552]
                  
                  
                  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)
                  
                  
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â9
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â10
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â9
               
               
                  
                     
                  
               
            
         
      
         TANF Economic Response Fund                                                                                              
            
         
         TANF Economic Response Fund                                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1539â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  2,000
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  2,000
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  2,000
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â28
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â28
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  2,000
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  28
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  2,000
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  28
               
               
                  
                     
                  
               
            
         
      
      
         This account establishes a $2 billion TANF Economic Response Fund to assist States during periods of economic downturns. 
            It includes an effective economic trigger to determine if States qualify for funding under this account based on economic
            need.
         
      
         Emergency Aid and Service Connection Grants                                                                              
            
         
         Emergency Aid and Service Connection Grants                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1538â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Direct program activity
                  
                  
                  40
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  40
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  40
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  40
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  40
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  39
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  39
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  40
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  40
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  1
               
               
                  
                     
                  
               
            
         
      
      
         This account establishes Emergency Aid and Service Connection Grants.  This program would fund a robust round of pilots to
            test new approaches for providing emergency aid for low-income families, including both short-term financial assistance and
            connection to longer-term supports for those who need them.  The Budget includes budget authority of $2 billion over five
            years for this program.
         
      
         Payments to states for child support enforcement and family support programsFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
         of July 5, 1960 (24 U.S.C. 321â329), [$2,944,906,000] $3,010,631,000, to remain available until expended; and for such purposes for the first quarter of fiscal year [2017] 2018, [$1,300,000,000] $1,400,000,000,  to remain available until expended.
      
      For carrying out, after May 31 of the current fiscal year, 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  3,726
                  3,727
                  3,881
               
               
                  0002
                  Child support incentive payments
                  564
                  517
                  586
               
               
                  0003
                  Access and visitation grants
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  4,300
                  4,254
                  4,477
               
               
                  0102
                  Payments to territories
                  33
                  33
                  33
               
               
                  0103
                  Repatriation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  34
                  34
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,334
                  4,288
                  4,511
               
               
                  0801
                  Offset obligations (CSE grants to States)
                  13
                  16
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  4,347
                  4,304
                  4,524
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  189
                  200
                  200
               
               
                  1029
                  Other balances withdrawn to Treasury
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  176
                  200
                  200
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,908
                  2,928
                  3,011
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  1,250
                  1,160
                  1,300
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  13
                  16
                  13
               
               
                  1900
                  Budget authority (total)
                  4,171
                  4,104
                  4,324
               
               
                  1930
                  Total budgetary resources available
                  4,347
                  4,304
                  4,524
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  942
                  1,047
                  968
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  4,347
                  4,304
                  4,524
               
               
                  3020
                  Outlays (gross)
                  â4,053
                  â4,183
                  â4,303
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â189
                  â200
                  â200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,047
                  968
                  989
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  942
                  1,047
                  968
               
               
                  3200
                  Obligated balance, end of year
                  1,047
                  968
                  989
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,171
                  4,104
                  4,324
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,586
                  3,542
                  3,734
               
               
                  4101
                  Outlays from mandatory balances
                  467
                  641
                  569
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,053
                  4,183
                  4,303
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â13
                  â16
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  4,158
                  4,088
                  4,311
               
               
                  4190
                  Outlays, net (total)
                  4,040
                  4,167
                  4,290
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,158
                  4,088
                  4,311
               
               
                  
                  Outlays
                  4,040
                  4,167
                  4,290
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  31
               
               
                  
                  Outlays
                  
                  
                  31
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,158
                  4,088
                  4,342
               
               
                  
                  Outlays
                  4,040
                  4,167
                  4,321
               
               
                  
                     
                  
               
            
         
      
      
         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.
            Proposals target systems modernization, increased collections, expanded distribution, and improved program efficiency.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  4,334
                  4,288
                  4,511
               
               
                  99.0
                  Reimbursable obligations
                  13
                  16
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  4,347
                  4,304
                  4,524
               
               
                  
                     
                  
               
            
         
      
         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 075â1501â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  
                  
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  
                  
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  31
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  31
               
               
                  1900
                  Budget authority (total)
                  
                  
                  31
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  31
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  31
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â31
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  31
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  31
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  31
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  31
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  1
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  5
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  31
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  18
               
               
                  
                     
                  
               
            
         
      
         Low income home energy assistanceFor making payments under subsections (b) and (d) of section 2602 of the Low Income Home Energy Assistance Act of 1981, [$3,390,304,000] $3,000,304,000: Provided, That all but [$491,000,000] $435,000,000 of this amount shall be allocated as though the total appropriation for such payments for fiscal year [2016] 2017 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: Provided further, That notwithstanding section 2605(k) of the Low-Income Home Energy Assistance Act of 1981, a state receiving
            an allotment for fiscal year 2017 may use up to 40 percent of such allotment for residential weatherization or other energy-related
            home repair activities without regard to the waiver process specified in such section. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  LIHEAP Block Grant
                  3,395
                  3,390
                  3,000
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  5
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,390
                  3,390
                  3,000
               
               
                  1930
                  Total budgetary resources available
                  3,395
                  3,390
                  3,000
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,201
                  1,134
                  1,311
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  3,395
                  3,390
                  3,000
               
               
                  3020
                  Outlays (gross)
                  â3,437
                  â3,213
                  â2,805
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,134
                  1,311
                  1,506
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,201
                  1,134
                  1,311
               
               
                  3200
                  Obligated balance, end of year
                  1,134
                  1,311
                  1,506
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,390
                  3,390
                  3,000
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,439
                  2,136
                  1,890
               
               
                  4011
                  Outlays from discretionary balances
                  998
                  1,077
                  915
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,437
                  3,213
                  2,805
               
               
                  4180
                  Budget authority, net (total)
                  3,390
                  3,390
                  3,000
               
               
                  4190
                  Outlays, net (total)
                  3,437
                  3,213
                  2,805
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  3,390
                  3,390
                  3,000
               
               
                  
                  Outlays
                  3,437
                  3,213
                  2,805
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  769
               
               
                  
                  Outlays
                  
                  
                  560
               
               
                  Total:
               
               
                  
                  Budget Authority
                  3,390
                  3,390
                  3,769
               
               
                  
                  Outlays
                  3,437
                  3,213
                  3,365
               
               
                  
                     
                  
               
            
         
      
      
         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 to establish a contingency fund
            providing additional mandatory funds to respond to increases in the number of low-income households, spikes in the price of
            natural gas, electricity, or oil, and extreme cold at the beginning of winter.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,393
                  3,388
                  2,998
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  3,395
                  3,390
                  3,000
               
               
                  
                     
                  
               
            
         
      
         Low Income Home Energy Assistance                                                                                        
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Mandatory LIHEAP Contingency Fund
                  
                  
                  769
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  769
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriations, mandatory
                  
                  
                  769
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  769
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  769
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â560
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  209
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  209
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  769
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  560
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  769
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  560
               
               
                  
                     
                  
               
            
         
      
         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, [$1,674,691,000] $2,089,860,000, of which [$1,645,201,000] $2,044,485,000 shall remain available through September 30, [2018] 2019 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 the limitation in section 205 of this Act regarding transfers increasing any appropriation shall apply to transfers
         to appropriations under this heading by substituting "10 percent" for "3 percent": Provided further, That the Secretary may accept and use money, funds, property, and services of any kind made available
            by gift, devise, bequest, grant, or other donation for carrying out activities to combat human trafficking and to assist trafficking
            victims under the authorities specified under this heading: Provided further, That, at any point after January 1, 2017, and
            before October 1, 2017, if the Secretary has increased funding available under this heading by at least 3 percent by transfer
            from other accounts to support higher than expected caseloads, and if the Secretary, in consultation with the Secretary of
            Homeland Security, determines that the percentage increase in the cumulative number of unaccompanied children transferred
            to the custody of the Secretary pursuant to such section 235 for the current fiscal year over the number transferred through
            the comparable date in the previous fiscal year (the caseload ratio) exceeds the trigger percentage specified in the next
            proviso, an additional $100,000,000 shall be available under this heading to carry out such sections 462 and 235: Provided
            further, That the trigger percentage referenced in the previous proviso is calculated by taking the unobligated balances for
            the Unaccompanied Children program at the end of the previous fiscal year, adding the difference between the amounts appropriated
            under this heading for the Unaccompanied Children program for the current fiscal year and obligations for such program for
            the previous fiscal year, dividing the result by the obligations for such program for the previous fiscal year, and adding
            five percentage points to the resulting amount (expressed as a percentage): Provided further, That for every 10 percentage
            point increment in the caseload ratio above the trigger percentage, an additional $100,000,000 shall be available under this
            heading to carry out such sections 462 and 235: Provided further, That the total additional amount available pursuant to the
            three preceding provisos shall not exceed $400,000,000. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Refugee and entrant assistance
                  643
                  697
                  819
               
               
                  0002
                  Assistance for treatment of torture victims
                  11
                  11
                  23
               
               
                  0003
                  Unaccompanied alien children
                  728
                  1,226
                  1,321
               
               
                  0005
                  Trafficking Victims program
                  16
                  19
                  22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,398
                  1,953
                  2,185
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4
                  278
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  113
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  117
                  278
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Base Appropriation
                  1,560
                  1,675
                  2,090
               
               
                  1100
                  UC Contingency Fund
                  
                  
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,560
                  1,675
                  2,185
               
               
                  1930
                  Total budgetary resources available
                  1,677
                  1,953
                  2,185
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  278
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  776
                  781
                  1,222
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,398
                  1,953
                  2,185
               
               
                  3020
                  Outlays (gross)
                  â1,270
                  â1,512
                  â1,995
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â113
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  781
                  1,222
                  1,412
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  776
                  781
                  1,222
               
               
                  3200
                  Obligated balance, end of year
                  781
                  1,222
                  1,412
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,560
                  1,675
                  2,185
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  770
                  838
                  1,092
               
               
                  4011
                  Outlays from discretionary balances
                  500
                  674
                  903
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,270
                  1,512
                  1,995
               
               
                  4180
                  Budget authority, net (total)
                  1,560
                  1,675
                  2,185
               
               
                  4190
                  Outlays, net (total)
                  1,270
                  1,512
                  1,995
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
            programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
            for refugee benefits. The account also includes funding for the rehabilitation of victims of torture and human trafficking
            and for the care and placement of unaccompanied children. The President's 2017 Budget includes funding to serve additional
            refugees and eligible entrants, provide shelter to unaccompanied children, and expand direct services to domestic victims
            of human trafficking.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Direct obligations: Personnel compensation: Full-time permanent
                  7
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  7
                  8
                  8
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  3
               
               
                  23.1
                  Rental payments to GSA
                  4
                  4
                  4
               
               
                  25.1
                  Advisory and assistance services
                  44
                  256
                  350
               
               
                  25.2
                  Other services from non-Federal sources
                  17
                  4
                  7
               
               
                  25.3
                  Other goods and services from Federal sources
                  57
                  57
                  58
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,267
                  1,622
                  1,755
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,398
                  1,953
                  2,185
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  103
                  106
                  109
               
               
                  1101
                  Direct military average strength employment
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable FamiliesFor carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out,
         except as otherwise provided, section 437 of such Act, [$59,765,000] $79,765,000: Provided, That of the funds available to carry out such section 437, $59,765,000 shall be allocated consistent
            with subsections (b) and (c) of such section: Provided further, That $20,000,000 shall be used to increase the amount available
            for allotments under subsection (c)(1) of such section 437, with subsection (d)(1) of such section not applying to such funds:
            Provided further, That section 432(b)(2)(B) of such Act shall not apply to funds provided under this heading for fiscal year
            2017: Provided further, That notwithstanding section 433(a) of such Act, each Indian tribe or tribal consortium with an approved
            plan shall receive an allotment of not less than $10,000: Provided further, That for purposes of funds provided under this
            heading, an Indian tribe or tribal consortium may apply the term "adoption" in a manner that includes customary adoptions.  (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  342
                  342
                  383
               
               
                  0002
                  Research, training and technical assistance
                  8
                  9
                  9
               
               
                  0003
                  State court improvement activities
                  29
                  31
                  33
               
               
                  0004
                  Family Connection Grants
                  2
                  2
                  2
               
               
                  0005
                  PREP
                  73
                  89
                  81
               
               
                  0006
                  Abstinence Education
                  47
                  75
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  501
                  548
                  583
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  26
                  10
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  6
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  25
                  26
                  10
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  60
                  80
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  470
                  495
                  495
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â25
                  â23
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  445
                  472
                  495
               
               
                  1900
                  Budget authority (total)
                  505
                  532
                  575
               
               
                  1930
                  Total budgetary resources available
                  530
                  558
                  585
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â3
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  26
                  10
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  609
                  537
                  579
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  501
                  548
                  583
               
               
                  3020
                  Outlays (gross)
                  â526
                  â506
                  â529
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â17
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  537
                  579
                  633
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  609
                  537
                  579
               
               
                  3200
                  Obligated balance, end of year
                  537
                  579
                  633
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  60
                  60
                  80
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  23
                  20
                  27
               
               
                  4011
                  Outlays from discretionary balances
                  42
                  40
                  40
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  65
                  60
                  67
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  445
                  472
                  495
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  109
                  100
                  107
               
               
                  4101
                  Outlays from mandatory balances
                  352
                  346
                  355
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  461
                  446
                  462
               
               
                  4180
                  Budget authority, net (total)
                  505
                  532
                  575
               
               
                  4190
                  Outlays, net (total)
                  526
                  506
                  529
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  505
                  532
                  575
               
               
                  
                  Outlays
                  526
                  506
                  529
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â17
               
               
                  
                  Outlays
                  
                  
                  1
               
               
                  Total:
               
               
                  
                  Budget Authority
                  505
                  532
                  558
               
               
                  
                  Outlays
                  526
                  506
                  530
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds for a broad range of child welfare services, including family preservation and family support
            services, through Promoting Safe and Stable Families. The Budget includes a five-year reauthorization of the Personal Responsibility
            Education Program (PREP) through FY 2022, a reauthorization of Family Connection Grants through FY 2021, an expansion of grants
            to increase the well-being of, and to improve the permanency outcomes for, children affected by substance abuse, additional
            funding for Tribal Court Improvement Programs, and a $20 million increase in discretionary appropriations for Promoting Safe
            and Stable Families to increase capacity for tribal child welfare systems .
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  12
                  12
                  13
               
               
                  25.3
                  Other goods and services from Federal sources
                  3
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  485
                  533
                  567
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  501
                  548
                  583
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  9
                  9
                  13
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable Families                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  
                  
                  40
               
               
                  0003
                  State court improvement activities
                  
                  
                  3
               
               
                  0004
                  Family Connection Grants
                  
                  
                  15
               
               
                  0006
                  Abstinence Education
                  
                  
                  â75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  â17
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â17
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â17
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â17
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â18
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â18
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â17
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  
                  1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â17
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  1
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  9
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  â26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  â17
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Mandatory child care
                  1,178
                  1,178
                  1,178
               
               
                  0002
                  Matching child care
                  1,708
                  1,662
                  1,660
               
               
                  0003
                  Training and technical assistance
                  
                  15
                  15
               
               
                  0004
                  Child care tribal grants
                  58
                  58
                  58
               
               
                  0005
                  Research
                  
                  4
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,944
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  27
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,917
                  2,917
                  2,917
               
               
                  1930
                  Total budgetary resources available
                  2,944
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  830
                  927
                  894
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,944
                  2,917
                  2,917
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,821
                  â2,950
                  â2,937
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â28
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  927
                  894
                  874
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  830
                  927
                  894
               
               
                  3200
                  Obligated balance, end of year
                  927
                  894
                  874
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,151
                  2,276
                  2,276
               
               
                  4101
                  Outlays from mandatory balances
                  670
                  674
                  661
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,821
                  2,950
                  2,937
               
               
                  4180
                  Budget authority, net (total)
                  2,917
                  2,917
                  2,917
               
               
                  4190
                  Outlays, net (total)
                  2,821
                  2,950
                  2,937
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays
                  2,821
                  2,950
                  2,937
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  3,665
               
               
                  
                  Outlays
                  
                  
                  2,969
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  6,582
               
               
                  
                  Outlays
                  2,821
                  2,950
                  5,906
               
               
                  
                     
                  
               
            
         
      
      
         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, 2016 (P.L. 114â113). The Budget includes an $82 billion investment over ten years above current law to expand access
            to high-quality child care for all low- and moderate-income families with young children.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  15
                  15
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,944
                  2,902
                  2,902
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,944
                  2,917
                  2,917
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Matching child care
                  
                  
                  3,574
               
               
                  0003
                  Training and technical assistance
                  
                  
                  18
               
               
                  0004
                  Child care tribal grants
                  
                  
                  73
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  3,665
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  3,665
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  3,665
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  3,665
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â2,969
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  696
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  696
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  3,665
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2,969
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  3,665
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  2,969
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  23
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  3,642
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  3,665
               
               
                  
                     
                  
               
            
         
      
         Payments to states for the child care and development block grantFor carrying out the Child Care and Development Block Grant Act of 2014 ("CCDBG Act"), [$2,761,000,000] $2,961,672,000  shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families:
         Provided, That, in addition to the amounts [required to be reserved by the States under section 658G of the CCDBG Act, $127,206,000 shall be for activities that improve
         the quality of infant and toddler care] reserved under section 658O(a)(5) of the CCDBG Act, $40,000,000 shall be for carrying out a program of competitive grants
            to States, territories, tribes, local governments, and public entities, to develop, implement, and evaluate models of providing
            care for working families in rural communities, families needing child care on an emergency basis, families with non-traditional
            work hours, or other family needs as identified by the Secretary: 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 all funds made available to carry out section 418 of the Social Security Act (42 U.S.C. 618), including funds appropriated
         for that purpose in such section 418 or any other provision of law, shall be subject to the reservation of funds authority
         in paragraphs (4) and (5) of section 658O(a) of the CCDBG Act.  (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Block grant payments to States
                  2,425
                  2,751
                  2,912
               
               
                  0002
                  Child care pilots for working families
                  
                  
                  40
               
               
                  0004
                  Research and evaluation fund
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  2,435
                  2,761
                  2,962
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,435
                  2,761
                  2,962
               
               
                  1930
                  Total budgetary resources available
                  2,435
                  2,761
                  2,962
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  713
                  829
                  793
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  2,435
                  2,761
                  2,962
               
               
                  3020
                  Outlays (gross)
                  â2,313
                  â2,797
                  â2,940
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  829
                  793
                  815
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  713
                  829
                  793
               
               
                  3200
                  Obligated balance, end of year
                  829
                  793
                  815
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,435
                  2,761
                  2,962
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,751
                  2,154
                  2,310
               
               
                  4011
                  Outlays from discretionary balances
                  562
                  643
                  630
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,313
                  2,797
                  2,940
               
               
                  4180
                  Budget authority, net (total)
                  2,435
                  2,761
                  2,962
               
               
                  4190
                  Outlays, net (total)
                  2,313
                  2,797
                  2,940
               
               
                  
                     
                  
               
            
         
      
      
         This program provides grants to States for child care subsidies for low-income working families and activities to improve
            child care quality. In FY 2017, it also includes a new competitive pilot program to develop and evaluate effective strategies
            for meeting the child care needs of working families in rural communities and families needing emergency or non-traditional
            hour care.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  7
                  13
                  15
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  16
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,412
                  2,746
                  2,945
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  2,435
                  2,761
                  2,962
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
         Social services block grantFor making grants to States pursuant to section 2002 of the Social Security Act, supplementing research and evaluation related to activities funded by such grants, and for demonstration projects to improve
            access to child-rearing supplies, $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: Provided further, That notwithstanding section 2003(c) of such Act, the amount specified for allocation under such section
            for fiscal year 2017 shall be $1,681,500,000.  (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  1,576
                  1,584
                  1,700
               
               
                  0002
                  Health Profession Opportunity Grants
                  84
                  85
                  85
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,660
                  1,669
                  1,785
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  30
                  30
                  30
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,785
                  1,785
                  1,785
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â124
                  â116
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,661
                  1,669
                  1,785
               
               
                  1930
                  Total budgetary resources available
                  1,691
                  1,699
                  1,815
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  30
                  30
                  30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  769
                  591
                  489
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,660
                  1,669
                  1,785
               
               
                  3020
                  Outlays (gross)
                  â1,832
                  â1,771
                  â1,836
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  591
                  489
                  438
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  769
                  591
                  489
               
               
                  3200
                  Obligated balance, end of year
                  591
                  489
                  438
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,661
                  1,669
                  1,785
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,320
                  1,319
                  1,415
               
               
                  4101
                  Outlays from mandatory balances
                  512
                  452
                  421
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,832
                  1,771
                  1,836
               
               
                  4180
                  Budget authority, net (total)
                  1,661
                  1,669
                  1,785
               
               
                  4190
                  Outlays, net (total)
                  1,832
                  1,771
                  1,836
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,661
                  1,669
                  1,785
               
               
                  
                  Outlays
                  1,832
                  1,771
                  1,836
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  300
               
               
                  
                  Outlays
                  
                  
                  300
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,661
                  1,669
                  2,085
               
               
                  
                  Outlays
                  1,832
                  1,771
                  2,136
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  1
                  2
                  2
               
               
                  25.5
                  Research and development contracts
                  
                  
                  17
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,658
                  1,666
                  1,765
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,660
                  1,669
                  1,785
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8
                  8
                  10
               
               
                  
                     
                  
               
            
         
      
         Social Services Block Grant                                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0003
                  Upward Mobility Project
                  
                  
                  300
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  300
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  300
               
               
                  1900
                  Budget authority (total)
                  
                  
                  300
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  300
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  300
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â300
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  300
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  300
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  300
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  300
               
               
                  
                     
                  
               
            
         
      
         Children and families services programsFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Every Student Succeeds 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), part B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security
         Act [; for making payments under] , the Community Services Block Grant Act ("CSBG Act"), and the Assets for Independence Act; for necessary administrative expenses
         to carry out titles I, IV, V, X, XI, XIV, XVI, and XX-A of the Social Security Act, the Act of July 5, 1960,  the [Low Income Home Energy Assistance Act of 1981] Omnibus Budget Reconciliation 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, [$10,984,268,000] $11,725,057,000,  of which $37,943,000, to remain available through September 30, [2017] 2018, shall be for grants to States for adoption and legal guardianship incentive payments, as defined by section 473A of the
         Social Security Act and may be made for adoptions and legal guardianships completed before September 30, [2016] 2017: Provided, That [$9,168,095,000] $9,601,724,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, [$8,214,095,000] $8,639,724,000 shall be available for payments under section 640 of the Head Start Act, of which [$141,000,000] $131,629,000 shall be available for a cost of living adjustment notwithstanding section 640(a)(3)(A) of such Act: Provided further, That notwithstanding such section 640, of the amount in the second preceding proviso, [$294,000,000] $292,000,000 (of which up to one percent may be reserved for research and evaluation) shall be available through December 31, [2016] 2017 for award by the Secretary to grantees that apply for supplemental funding to increase their hours of program operations
         and for training and technical assistance for such activities: 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 notwithstanding such section 640, of the amount provided for making payments under the Head Start Act, and in addition
         to funds otherwise available under such section 640 [for such purposes], [$635,000,000] $645,000,000 shall be available through March 31, [2017] 2018 for 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, for 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,
         for training and technical assistance for such activities, and for up to $14,000,000 in Federal costs of administration and
         evaluation, and, notwithstanding section 645A(c)(2) of such Act, these funds are available to serve children under age 4:
         Provided further, That funds described in the preceding two provisos shall not be included in the calculation of "base grant" in subsequent
         fiscal years, as such term is used in section 640(a)(7)(A) of such Act: Provided further, That $350,000,000 shall be available until December 31, 2017 for carrying out sections 9212 and 9213 of
            the Every Student Succeeds Act: Provided further, That up to 5 percent of the funds in the previous proviso shall be available
            for technical assistance, evaluation, early education research, pilots to support the transition from preschool to elementary
            school, improve the early grades, and support exemplary child development practices, and other national activities related
            to such grants: Provided further, That [$751,383,000] $674,000,000 shall be for making payments under the CSBG Act:  Provided further, That [$36,733,000 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 $6,500,000 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 in addition to the reservation set forth in section 674(b)
            of the CSBG Act, the Secretary may reserve up to 1 percent of the amount for making payments under such Act for research and
            evaluation activities under such Act:  Provided further, That, notwithstanding section 675C(a)(3) of the CSBG Act, 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] such Act, and have not been expended by such entity, they shall remain with such entity for carryover into the next fiscal year
         for expenditure by such entity consistent with program purposes: [Provided further, That the Secretary shall establish procedures regarding the disposition of intangible assets and program income that permit
         such assets acquired with, and program income derived from, grant funds authorized under section 680 of the CSBG Act to become
         the sole property of such grantees after a period of not more than 12 years after the end of the grant period for any activity
         consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That intangible assets in the form of loans, equity investments and other debt instruments, and program income may be used
         by grantees for any eligible purpose consistent with section 680(a)(2)(A) of the CSBG Act: Provided further, That these procedures shall apply to such grant funds made available after November 29, 1999: Provided further, That funds appropriated for section 680(a)(2) of the CSBG Act shall be available for financing construction and rehabilitation
         and loans or investments in private business enterprises owned by community development corporations:]  Provided further, That the Secretary shall issue  performance standards for  [nonprofit organizations] entities receiving funds from State and territorial grantees under the CSBG Act, and such States and territories shall assure the implementation
         of such standards prior to September 30, [2016] 2017, and include information on such implementation in the report required by section 678E(a)(2) of such Act: Provided further, That the percentage of amounts payable to a State under section 675A or 675B of such Act that may be used
            for administrative expenses under section 675C(b)(2) may be increased above 5 percent, but not above 10 percent, to implement
            State plans, approved by the Secretary, for one-time investments in data systems modernization, data analysis capacity, and
            improved information exchange and interoperability of data systems: Provided further, That such plans must include improved
            ability to analyze and report program results, streamline service enrollment systems, or increase program integrity: Provided
            further, That the percentage specified in section 675C(a)(1) of such Act may be applied by decreasing it by the amount of
            the percentage increase in the second preceding proviso: Provided further, That the lead State agency shall ensure that local
            eligible entities will consider and include in their community action plans strategies to meet the needs of concentrated,
            persistent poverty in their service areas: Provided further, That notwithstanding the prior notice and hearing provisions
            in section 676(b)(8) and 678C of such Act, if the State determines that immediate temporary suspension of financial assistance
            to an eligible entity is necessary because of a serious risk of a substantial injury to property or loss of project funds,
            or because of a violation of a Federal, State, or local criminal statute, the State may submit a written request that the
            Secretary allow a temporary suspension of financial assistance to the eligible entity, in whole or part, and a reallocation
            of suspended financial assistance to other eligible entities for the provision of comparable services: Provided further, That, to the extent funds for the Assets for Independence (AFI) Act provided in this Act are distributed as grant funds
         to a qualified entity and have not been expended by such entity within 3 years after the date of the 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 5 years: Provided further, That notwithstanding section 414(e) of the AFI Act, up to $3,000,000 of the funds provided for such Act
            shall be available for research and evaluation: Provided further, That up to 30 percent of funds provided for carrying out
            the AFI Act shall be for grants to projects for which the Secretary may allow grantees to use any amount of such grant funds
            to assist participants in obtaining the skills and information necessary to achieve economic self-sufficiency, notwithstanding
            any provision of such Act, and for which the Secretary may expand the definition of "qualified expenses" under section 404(8)
            of such Act and waive the limitation of matching contribution to only earned income deposits under section 410(a)(1) of such
            Act: Provided further, That notwithstanding section 404(5)(A)(i) of such Act, contributions to an individual development account
            shall be allowable through any mechanism allowed by the financial institution at which the account is held: Provided further,
            That, for fiscal year 2017, section 414(d)(1) of the AFI Act shall be applied as if it stated: "(1) INTERIM REPORTS.âThe Secretary
            shall submit to Congress an annual, interim report based on the Federal fiscal year setting forth the results of the reports
            submitted pursuant to section 412(b). Such report shall be submitted by July 31 of the year following the period of the report.":
            Provided further, That of the amounts available for carrying out the Runaway and Homeless Youth Act, $2,350,000 shall be available
            for demonstration projects as described in section 343 of such Act, notwithstanding section 388(a) of such Act:  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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Head Start
                  8,717
                  9,168
                  9,602
               
               
                  0102
                  Head Start Emergency Hurricane Sandy funding
                  71
                  
                  
               
               
                  0103
                  Runaway and homeless youth (basic centers)
                  53
                  54
                  57
               
               
                  0104
                  Transitional living
                  44
                  48
                  49
               
               
                  0105
                  Prevalence, Needs and Characteristics of Homeless Youth
                  
                  
                  2
               
               
                  0106
                  Education grants to reduce sexual abuse of runaway youth
                  17
                  17
                  17
               
               
                  0107
                  Preschool Development Grants
                  
                  
                  350
               
               
                  0109
                  Child abuse State grants
                  25
                  25
                  25
               
               
                  0110
                  Child abuse discretionary activities
                  29
                  33
                  44
               
               
                  0111
                  Community-based child abuse prevention
                  40
                  40
                  40
               
               
                  0112
                  Child welfare services
                  269
                  269
                  269
               
               
                  0113
                  Child welfare training, research, or demonstration projects
                  16
                  18
                  22
               
               
                  0114
                  Adoption opportunities
                  39
                  39
                  39
               
               
                  0115
                  Abandoned infants assistance
                  11
                  
                  
               
               
                  0116
                  Adoption incentives
                  38
                  38
                  38
               
               
                  0117
                  Independent living training vouchers
                  43
                  43
                  43
               
               
                  0124
                  Native American programs
                  47
                  50
                  53
               
               
                  0125
                  Social services and income maintenance research
                  6
                  6
                  11
               
               
                  0128
                  Federal administration
                  199
                  205
                  206
               
               
                  0129
                  Center for faith-based and community initiatives
                  1
                  
                  
               
               
                  0131
                  Disaster human services case management
                  1
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Direct program activities, subtotal
                  9,666
                  10,055
                  10,869
               
               
                  0301
                  Community services block grant
                  674
                  715
                  674
               
               
                  0303
                  Rural community facilities
                  7
                  7
                  
               
               
                  0304
                  Community services discretionary (JOLI & CED)
                  30
                  30
                  
               
               
                  0306
                  Assets for independence
                  19
                  19
                  19
               
               
                  0308
                  Domestic violence hotline
                  4
                  8
                  12
               
               
                  0309
                  Family violence prevention and services
                  135
                  150
                  151
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0391
                  Direct program activities, subtotal
                  869
                  929
                  856
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total, direct program
                  10,535
                  10,984
                  11,725
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  10,535
                  10,984
                  11,725
               
               
                  0801
                  Children and Families Services Programs (Reimbursable)
                  6
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  6
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  10,541
                  11,004
                  11,745
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  562
                  377
                  382
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  562
                  377
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  568
                  377
                  382
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  10,346
                  10,984
                  11,725
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1
                  24
                  24
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  2
                  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)
                  10,350
                  11,009
                  11,750
               
               
                  1930
                  Total budgetary resources available
                  10,918
                  11,386
                  12,132
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  377
                  382
                  387
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  6,646
                  7,114
                  7,107
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  10,541
                  11,004
                  11,745
               
               
                  3011
                  Obligations incurred, expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â9,984
                  â11,011
                  â11,344
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â86
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,114
                  7,107
                  7,508
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â10
                  â5
                  â5
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5
                  â5
                  â5
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  6,636
                  7,109
                  7,102
               
               
                  3200
                  Obligated balance, end of year
                  7,109
                  7,102
                  7,503
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  10,348
                  11,008
                  11,749
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,059
                  4,639
                  4,950
               
               
                  4011
                  Outlays from discretionary balances
                  5,922
                  6,372
                  6,394
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  9,981
                  11,011
                  11,344
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â6
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â6
                  â24
                  â24
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  10,346
                  10,984
                  11,725
               
               
                  4080
                  Outlays, net (discretionary)
                  9,975
                  10,987
                  11,320
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  1
                  1
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  3
                  
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â3
                  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
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  â1
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  10,346
                  10,984
                  11,725
               
               
                  4190
                  Outlays, net (total)
                  9,975
                  10,986
                  11,319
               
               
                  
                     
                  
               
            
         
      
      
         The request totals $11.7 billion, including almost $10 billion for priority investments in early learning programs, such as
            Head Start and the newly transferred Preschool Development Grants program, that will expand access to high quality early care
            and education for young children. Relative to FY 2016, the Budget also requests an additional $5 million for family violence
            prevention and services, $11 million to provide comprehensive services to youth in the child welfare system, including those
            who are victims of or at-risk of human trafficking, $7 million to improve services for homeless youth, $2 million to support
            energy assistance evaluations, and $3 million for Native youth development. This request discontinues funding for the Rural
            Communities Facilities and the Community Economic Development programs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  104
                  122
                  124
               
               
                  11.3
                  Other than full-time permanent
                  4
                  5
                  6
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  109
                  128
                  131
               
               
                  12.1
                  Civilian personnel benefits
                  32
                  38
                  38
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  14
                  15
                  16
               
               
                  23.2
                  Rental payments to others
                  1
                  
                  
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  2
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  212
                  215
                  237
               
               
                  25.2
                  Other services from non-Federal sources
                  6
                  7
                  245
               
               
                  25.3
                  Other goods and services from Federal sources
                  59
                  60
                  51
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  10,093
                  10,511
                  10,997
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  10,535
                  10,984
                  11,725
               
               
                  99.0
                  Reimbursable obligations
                  6
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  10,541
                  11,004
                  11,745
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,022
                  1,123
                  1,192
               
               
                  1101
                  Direct military average strength employment
                  8
                  9
                  9
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  15
                  8
                  10
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical AssistanceFor expenses necessary, including for grants and technical assistance, for improving integration and interoperability of enrollment
            systems and data systems for federal, state, tribal, and local health and human services programs, including establishment
            of a Systems Innovation Center, $10,000,000. 
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Training and technical assistance
                  10
                  15
                  12
               
               
                  0002
                  Federal parent locator service
                  25
                  26
                  25
               
               
                  0004
                  Welfare research
                  14
                  14
                  15
               
               
                  0005
                  Advancing Human Services Interoperability - Discretionary
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  49
                  55
                  62
               
               
                  0801
                  Reimbursable program FPLS REIMB
                  23
                  35
                  37
               
               
                  0802
                  Reimbursable program activity CCDBG Research
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  37
                  35
                  37
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  86
                  90
                  99
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4
                  6
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6
                  6
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation - Advancing Human Services Interoperability
                  
                  
                  10
               
               
                  1121
                  Appropriations transferred from other acct [075â1522]
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  
                  25
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  37
                  37
                  37
               
               
                  1200
                  Appropriation [Pop-up]
                  
                  1
                  
               
               
                  1221
                  Appropriations transferred from other acct [075â1522]
                  15
                  15
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â4
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  48
                  50
                  37
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  15
                  
                  
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  23
                  35
                  36
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  
                  1
                  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)
                  23
                  35
                  37
               
               
                  1900
                  Budget authority (total)
                  86
                  85
                  99
               
               
                  1930
                  Total budgetary resources available
                  92
                  91
                  100
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  63
                  78
                  77
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  86
                  90
                  99
               
               
                  3020
                  Outlays (gross)
                  â69
                  â91
                  â82
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  78
                  77
                  94
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â6
                  â6
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  58
                  72
                  71
               
               
                  3200
                  Obligated balance, end of year
                  72
                  71
                  88
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  15
                  
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  3
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  â15
                  
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  71
                  85
                  74
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  19
                  23
                  22
               
               
                  4101
                  Outlays from mandatory balances
                  50
                  68
                  57
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  69
                  91
                  79
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â9
                  â10
                  â10
               
               
                  4123
                  Non-Federal sources
                  â14
                  â25
                  â26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â23
                  â35
                  â36
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  47
                  50
                  38
               
               
                  4170
                  Outlays, net (mandatory)
                  46
                  56
                  43
               
               
                  4180
                  Budget authority, net (total)
                  47
                  50
                  63
               
               
                  4190
                  Outlays, net (total)
                  31
                  56
                  46
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  2
                  2
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  2
                  2
                  1
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  47
                  50
                  63
               
               
                  
                  Outlays
                  31
                  56
                  46
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  50
               
               
                  
                  Outlays
                  
                  
                  5
               
               
                  Total:
               
               
                  
                  Budget Authority
                  47
                  50
                  113
               
               
                  
                  Outlays
                  31
                  56
                  51
               
               
                  
                     
                  
               
            
         
      
      
         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).
            For fiscal years 2010â2014, Welfare Research had been temporarily reauthorized ; for FY 2015 and FY 2016, annual appropriations
            provided funds for Welfare Research via a transfer from the TANF Contingency Fund. The Budget includes a general provision
            to transfer $15 million from the TANF Contingency Fund in FY 2017 to Welfare Research. The Budget proposes an initiative for
            Advancing Human Services Interoperability, as well as a number of proposals to provide access to the National Directory of
            New Hires while maintaining the integrity and privacy of the data in the directory.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  6
                  8
                  8
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  12
                  12
                  17
               
               
                  25.2
                  Other services from non-Federal sources
                  16
                  17
                  16
               
               
                  25.3
                  Other goods and services from Federal sources
                  5
                  6
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2
                  4
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  49
                  55
                  63
               
               
                  99.0
                  Reimbursable obligations
                  37
                  35
                  36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  86
                  90
                  99
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  48
                  60
                  67
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0003
                  Advance Human Services Interoperability - Mandatory proposal
                  
                  
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  50
               
               
                  0801
                  Reimbursable program FPLS REIMB
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  53
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  50
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  3
               
               
                  1900
                  Budget authority (total)
                  
                  
                  53
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  53
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  53
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  45
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  45
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  53
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  8
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  50
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  5
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  5
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  45
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  50
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  53
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  5
               
               
                  
                     
                  
               
            
         
      
         Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, [$5,298,000,000] $5,764,000,000.
      
      For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
         [2017] 2018, [$2,300,000,000] $2,500,000,000.
      
      For carrying out, after May 31 of the current fiscal year, 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  4,669
                  4,801
                  4,992
               
               
                  0002
                  Independent living
                  140
                  140
                  140
               
               
                  0004
                  Adoption assistance
                  2,473
                  2,674
                  2,780
               
               
                  0005
                  Guardianship
                  101
                  135
                  152
               
               
                  0006
                  Tribal T&TA
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  7,386
                  7,753
                  8,067
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  5,186
                  5,457
                  5,767
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  5,186
                  5,455
                  5,767
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  2,200
                  2,300
                  2,300
               
               
                  1900
                  Budget authority (total)
                  7,386
                  7,755
                  8,067
               
               
                  1930
                  Total budgetary resources available
                  7,386
                  7,755
                  8,069
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,232
                  1,090
                  1,365
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  7,386
                  7,753
                  8,067
               
               
                  3011
                  Obligations incurred, expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â7,314
                  â7,478
                  â7,805
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â215
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,090
                  1,365
                  1,627
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,232
                  1,090
                  1,365
               
               
                  3200
                  Obligated balance, end of year
                  1,090
                  1,365
                  1,627
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  7,386
                  7,755
                  8,067
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6,530
                  6,602
                  6,928
               
               
                  4101
                  Outlays from mandatory balances
                  784
                  876
                  877
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  7,314
                  7,478
                  7,805
               
               
                  4180
                  Budget authority, net (total)
                  7,386
                  7,755
                  8,067
               
               
                  4190
                  Outlays, net (total)
                  7,314
                  7,478
                  7,805
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  7,386
                  7,755
                  8,067
               
               
                  
                  Outlays
                  7,314
                  7,478
                  7,805
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  505
               
               
                  
                  Outlays
                  
                  
                  253
               
               
                  Total:
               
               
                  
                  Budget Authority
                  7,386
                  7,755
                  8,572
               
               
                  
                  Outlays
                  7,314
                  7,478
                  8,058
               
               
                  
                     
                  
               
            
         
      
      
         This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, 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 174,500 children
            per month are estimated to be served in FY 2017.
         
         Adoption AssistanceâThe proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
            An average of 467,500 children per month are estimated to be served in FY 2017.
         
         Guardianship Assistance ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 29,300 children per month are estimated to be served in FY 2017.
         
         This account includes new investments to promote family-based care and increase oversight on the use of congregate care, to
            provide federal reimbursement for prevention and permanency interventions, to invest in the child welfare workforce by expanding
            support for caseworkers to pursue BSW/MSW degrees and incentivizing grantees to hire caseworkers with such degrees, to enhance
            support for child welfare IT investments, and to provide additional support for new direct Tribal IV-E programs. Additionally,
            this account includes a proposed demonstration project to address the 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. In addition, the Budget proposes to allow the title IV-E agencies that have extended foster care to age 21 to
            use existing Chafee Foster Care Independence Program funds to serve young people formerly in foster care through age 23 and
            provides additional funding to establish an evidence base for how to best serve older youth in the child welfare system.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  30
                  37
                  35
               
               
                  41.0
                  Grants, subsidies, and contributions
                  7,355
                  7,715
                  8,031
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  7,386
                  7,753
                  8,067
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2015 actual
                  2016 est.
                  2017 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 075â1545â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  
                  
                  251
               
               
                  0002
                  Independent living
                  
                  
                  4
               
               
                  0003
                  Demonstration to Address Over-Prescription of Psychotropic Drugs for Children in Foster Care
                  
                  
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  
                  
                  305
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  505
               
               
                  1900
                  Budget authority (total)
                  
                  
                  505
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  505
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  200
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  305
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â253
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  52
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  52
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  505
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  253
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  505
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  253
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â4â1â609
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  23
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  282
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  305
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â4â1â609
                  2015 actual
                  2016 est.
                  2017 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, sections 1252 and 1253 of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of
         2008, 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, the Assistive Technology Act of 1998, titles II and VII
         (and section 14 with respect to such titles) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy
         and program activities that assist individuals with disabilities, [$1,912,735,000] $1,941,179,000,  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 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 of amounts made available under this heading to carry out sections 311, 331, and 336 of the OAA, up
            to one percent of such amounts shall be available for developing and implementing evidence-based practices for enhancing senior
            nutrition:  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 $2,000,000 shall be for competitive grants to support alternative financing programs that provide for the purchase
         of assistive technology devices, such as a low-interest loan fund; an interest buy-down program; a revolving loan fund; a
         loan guarantee; or an insurance program: Provided further, That applicants shall provide an assurance that, and information describing the manner in which, the alternative financing
         program will expand and emphasize consumer choice and control: Provided further, That State agencies and community-based disability organizations that are directed by and operated for individuals with
         disabilities shall be eligible to compete: Provided further, That in addition, the unobligated balance of amounts previously made available for the Health Resources and Services Administration
         to carry out functions under sections 1252 and 1253 of the PHS Act shall be transferred to this account, except for such sums
         as may be necessary to provide for an orderly transition of such functions to the Administration for Community Living: Provided further, That none of the funds made available under this heading may be used by an eligible system (as defined in section 102 of
         the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action
         in a Federal or State court on behalf of an individual or group of individuals with a developmental disability (as defined
         in section 102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A))
         that is attributable to a mental impairment (or a combination of mental and physical impairments), that has as the requested
         remedy the closure of State operated intermediate care facilities for people with intellectual or developmental disabilities,
         unless reasonable public notice of the action has been provided to such individuals (or, in the case of mental incapacitation,
         the legal guardians who have been specifically awarded authority by the courts to make healthcare and residential decisions
         on behalf of such individuals) who are affected by such action, within 90 days of instituting such legal action, which informs
         such individuals (or such legal guardians) of their legal rights and how to exercise such rights consistent with current Federal
         Rules of Civil Procedure: Provided further, That the limitations in the immediately preceding proviso shall not apply in the case of an individual who is neither competent
         to consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who are a ward of the State or
         subject to public guardianship]. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Home and community-based supportive services
                  348
                  348
                  358
               
               
                  0102
                  Preventive health services
                  20
                  20
                  20
               
               
                  0103
                  National family caregiver support program
                  146
                  150
                  150
               
               
                  0104
                  Native American caregiver support program
                  6
                  8
                  8
               
               
                  0105
                  Congregate nutrition services
                  438
                  448
                  454
               
               
                  0106
                  Home-delivered nutrition services
                  216
                  227
                  234
               
               
                  0107
                  Nutrition services incentive program
                  158
                  158
                  159
               
               
                  0108
                  Native American nutrition and supportive services
                  26
                  31
                  31
               
               
                  0110
                  Aging network support activities
                  10
                  10
                  10
               
               
                  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
                  5
                  5
               
               
                  0114
                  Program administration
                  35
                  40
                  41
               
               
                  0115
                  Lifespan respite care program
                  2
                  3
                  5
               
               
                  0116
                  Paralysis Resource Center
                  7
                  8
                  8
               
               
                  0117
                  Aging and Disability Resource Centers (ADRC)
                  6
                  6
                  8
               
               
                  0118
                  Chronic Disease Self-Management Education Program PPHF
                  8
                  8
                  8
               
               
                  0121
                  Senior Medicare Patrol program
                  9
                  
                  
               
               
                  0122
                  Elder Rights Support Activities
                  8
                  12
                  14
               
               
                  0123
                  Falls Prevention - PPHF
                  5
                  5
                  5
               
               
                  0127
                  Alzheimer's Disease Communications Campaign PPHF
                  4
                  4
                  4
               
               
                  0133
                  Alzheimer's Disease Initiative - Services PPHF
                  10
                  11
                  11
               
               
                  0136
                  Voting Access for People With Disabilities (HAVA)
                  5
                  5
                  5
               
               
                  0138
                  State Councils on Developmental Disabilities
                  71
                  73
                  73
               
               
                  0139
                  Protection and Advocacy
                  39
                  39
                  39
               
               
                  0141
                  University Centers for Excellence in Developmental Disabilities
                  38
                  39
                  39
               
               
                  0142
                  Projects of National Significance
                  9
                  10
                  10
               
               
                  0144
                  Limb Loss Resource Center
                  3
                  3
                  3
               
               
                  0145
                  National Institute on Disability, Independent Living & Rehab Research
                  103
                  104
                  104
               
               
                  0146
                  Independent Living - State Grants
                  
                  23
                  23
               
               
                  0147
                  Independent Living - Centers (CILs)
                  78
                  78
                  78
               
               
                  0148
                  Assistive Technology
                  2
                  34
                  32
               
               
                  0149
                  Traumatic Brain Injury (TBI)
                  
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  1,835
                  1,940
                  1,969
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  1,835
                  1,940
                  1,969
               
               
                  0801
                  Reimbursable program - HCFAC and Other
                  12
                  9
                  9
               
               
                  0802
                  ADRC's MIPPA (MACRA)
                  5
                  5
                  5
               
               
                  0803
                  Area Agencies on Aging - MIPPA (MACRA)
                  7
                  8
                  8
               
               
                  0804
                  MIPPA - Natl Center Benefits Outreach Enrollment (MACRA)
                  5
                  12
                  12
               
               
                  0805
                  SHIP - (DISC)
                  52
                  52
                  52
               
               
                  0806
                  Senior Medicare Patrol Program (Disc - CMS)
                  
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  81
                  95
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,916
                  2,035
                  2,064
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,621
                  1,913
                  1,941
               
               
                  1120
                  Appropriations transferred to other accts [012â3507]
                  â3
                  â2
                  
               
               
                  1121
                  Appropriations transferred from other acct [091â0301]
                  184
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [091â0800]
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,807
                  1,911
                  1,941
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â0116]
                  28
                  28
                  28
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  6
                  61
                  61
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  47
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  53
                  61
                  61
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  10
                  34
                  34
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  27
                  34
                  34
               
               
                  1900
                  Budget authority (total)
                  1,915
                  2,034
                  2,064
               
               
                  1930
                  Total budgetary resources available
                  1,918
                  2,035
                  2,064
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  895
                  1,247
                  979
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,916
                  2,035
                  2,064
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,750
                  â2,303
                  â2,024
               
               
                  3031
                  Unpaid obligations transferred from other accts [091â0301]
                  196
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,247
                  979
                  1,019
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â94
                  â104
                  â104
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â64
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  54
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â104
                  â104
                  â104
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  801
                  1,143
                  875
               
               
                  3200
                  Obligated balance, end of year
                  1,143
                  875
                  915
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,860
                  1,972
                  2,002
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  975
                  1,216
                  1,235
               
               
                  4011
                  Outlays from discretionary balances
                  727
                  1,059
                  743
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,702
                  2,275
                  1,978
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â52
                  â61
                  â61
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â47
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  46
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  1,807
                  1,911
                  1,941
               
               
                  4080
                  Outlays, net (discretionary)
                  1,650
                  2,214
                  1,917
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  55
                  62
                  62
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  8
                  8
               
               
                  4101
                  Outlays from mandatory balances
                  46
                  20
                  38
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  48
                  28
                  46
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â18
                  â34
                  â34
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â17
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  28
                  28
                  28
               
               
                  4170
                  Outlays, net (mandatory)
                  30
                  â6
                  12
               
               
                  4180
                  Budget authority, net (total)
                  1,835
                  1,939
                  1,969
               
               
                  4190
                  Outlays, net (total)
                  1,680
                  2,208
                  1,929
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the Administration for Community Living (ACL) reflects the actual distribution of
            the allocation account for 2015. Future allocations will be determined annually.
         
          This account funds formula and discretionary grants that provide home and community-based services and supports to assist
            older adults and people of all ages with disabilities to live independently and to fully participate in their communities.
            ACL works with states, localities, tribal organizations, nonprofit organizations, businesses and families, and through networks
            of aging and disability organizations, to provide these services and supports which include nutrition, supportive, caregiver,
            independent living and protection and advocacy services. Beginning in FY 2016, this account also provides funding for the
            Traumatic Brain Injury (TBI) program, which was transferred to ACL from the Health Resources and Services Administration.
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  19
                  22
                  25
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  6
                  7
               
               
                  23.1
                  Rental payments to GSA
                  2
                  3
                  4
               
               
                  25.1
                  Advisory and assistance services
                  24
                  28
                  29
               
               
                  25.3
                  Other goods and services from Federal sources
                  8
                  8
                  8
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,776
                  1,874
                  1,898
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1,835
                  1,941
                  1,971
               
               
                  99.0
                  Reimbursable obligations
                  81
                  94
                  93
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,916
                  2,035
                  2,064
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  167
                  184
                  211
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  18
                  22
                  23
               
               
                  
                     
                  
               
            
         
      
         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, [$456,009,000] $463,492,000, together with [$64,828,000] $66,078,000 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,] the funds made available under this heading, $53,900,000 shall be for minority AIDS prevention and treatment activities: Provided further, That of the funds made available under this heading, [$101,000,000] $104,790,000 shall be for making competitive contracts and grants to public and private entities to fund medically accurate and age appropriate
         programs that reduce teen pregnancy and for the Federal costs associated with administering and evaluating such contracts
         and grants, of which not more than 10 percent of the available funds shall be for training and technical assistance, evaluation,
         outreach, and additional program support activities, and of the remaining amount 75 percent 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, and 25 percent shall be available for research and demonstration grants
         to develop, replicate, refine, and test additional models and innovative strategies for preventing teenage pregnancy: Provided further, That of the amounts provided under this heading from amounts available under section 241 of the PHS Act, $6,800,000 shall
         be available to carry out evaluations (including longitudinal evaluations) of teenage pregnancy prevention approaches: [Provided further, That of the funds made available under this heading, $10,000,000 shall be for making competitive grants which exclusively
         implement education in sexual risk avoidance (defined as voluntarily refraining from non-marital sexual activity): Provided further, That funding for such competitive grants for sexual risk avoidance shall use medically accurate information referenced to
         peer-reviewed publications by educational, scientific, governmental, or health organizations; implement an evidence-based
         approach integrating research findings with practical implementation that aligns with the needs and desired outcomes for the
         intended audience; and teach the benefits associated with self-regulation, success sequencing for poverty prevention, healthy
         relationships, goal setting, and resisting sexual coercion, dating violence, and other youth risk behaviors such as underage
         drinking or illicit drug use without normalizing teen sexual activity: Provided further, That no more than 10 percent of the funding for such competitive grants for sexual risk avoidance shall be available for
         technical assistance and administrative costs of such programs: 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)] Provided further, That of the funds made available under this heading, $1,750,000 shall be for strengthening the Department's
            workforce capacity and capabilities, including training, recruiting, retaining, and hiring members of the acquisition workforce
            as defined by 41 U.S.C. 1703, for information technology in support of acquisition workforce effectiveness, and for management
            solutions to improve acquisition management: Provided further, That funds made available under this heading may also be used
            for activities to encourage innovative approaches to increase efficiency and effectiveness in the Department's programs. 
      In addition, to supplement the Department's activities related to implementation of the Digital Accountability and Transparency
            Act (DATA Act; Public Law 113â101; 31 U.S.C. 6101 note), $10,320,000.
      In addition, for a Digital Service team for HHS, $5,000,000.  (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  General Departmental Management
                  448
                  456
                  479
               
               
                  0801
                  GDM (Collected)
                  153
                  170
                  171
               
               
                  0802
                  HCFAC (Mandatory)
                  9
                  10
                  10
               
               
                  0803
                  PHS Evaluation
                  65
                  65
                  66
               
               
                  0804
                  CMS Trust Funds (Mandatory)
                  12
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  239
                  250
                  252
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  687
                  706
                  731
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  9
                  9
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  8
                  9
                  9
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  448
                  456
                  479
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  93
                  235
                  237
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  128
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  221
                  235
                  237
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  9
                  15
                  15
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  21
                  15
                  15
               
               
                  1900
                  Budget authority (total)
                  690
                  706
                  731
               
               
                  1930
                  Total budgetary resources available
                  698
                  715
                  740
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  9
                  9
                  9
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  532
                  534
                  517
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  687
                  706
                  731
               
               
                  3011
                  Obligations incurred, expired accounts
                  3
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â673
                  â723
                  â724
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  534
                  517
                  524
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â244
                  â220
                  â220
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â140
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  164
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â220
                  â220
                  â220
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  288
                  314
                  297
               
               
                  3200
                  Obligated balance, end of year
                  314
                  297
                  304
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  669
                  691
                  716
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  326
                  330
                  341
               
               
                  4011
                  Outlays from discretionary balances
                  333
                  378
                  368
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  659
                  708
                  709
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â231
                  â235
                  â237
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â231
                  â235
                  â237
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â128
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  138
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  448
                  456
                  479
               
               
                  4080
                  Outlays, net (discretionary)
                  428
                  473
                  472
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  21
                  15
                  15
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  10
                  10
                  10
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  14
                  15
                  15
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â31
                  â15
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  10
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â17
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  448
                  456
                  479
               
               
                  4190
                  Outlays, net (total)
                  411
                  473
                  472
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
            account for 2017. 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. FY 2017 Budget includes funding for staffing costs
            to build a Digital Service team that will focus on transforming the agency's digital services with the greatest impact to
            citizens and businesses so they are easier to use and maintain. The Budget also includes funding to implement the Digital
            Accountability and Transparency Act of 2014 to improve transparency of Federal spending and Government-wide financial data
            standards. The Department of Health and Human Services plays a crucial role in the implementation of the Act and has been
            designated as the leader for grants standardization.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  88
                  83
                  92
               
               
                  11.3
                  Other than full-time permanent
                  12
                  12
                  13
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  106
                  101
                  111
               
               
                  12.1
                  Civilian personnel benefits
                  27
                  26
                  28
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  4
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  17
                  17
                  17
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  2
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  27
                  22
                  25
               
               
                  25.2
                  Other services from non-Federal sources
                  37
                  42
                  36
               
               
                  25.3
                  Other goods and services from Federal sources
                  65
                  70
                  84
               
               
                  25.4
                  Operation and maintenance of facilities
                  5
                  6
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  5
                  5
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  148
                  155
                  155
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  448
                  456
                  479
               
               
                  99.0
                  Reimbursable obligations
                  239
                  250
                  252
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  687
                  706
                  731
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  955
                  937
                  1,015
               
               
                  1101
                  Direct military average strength employment
                  29
                  27
                  27
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  458
                  503
                  501
               
               
                  2101
                  Reimbursable military average strength employment
                  18
                  24
                  24
               
               
                  
                     
                  
               
            
         
      
         General Departmental Management                                                                                          
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0805
                  RAC Collections
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 11.1)
                  
                  
                  2
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  2
               
               
                  1900
                  Budget authority (total)
                  
                  
                  2
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  2
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  16
               
               
                  
                     
                  
               
            
         
      
         Office for civil rightsFor expenses necessary for the Office for Civil Rights, [$38,798,000] $42,705,000. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office for Civil Rights (Direct)
                  39
                  39
                  43
               
               
                  0801
                  Office for Civil Rights (Reimbursable)
                  5
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  44
                  45
                  49
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  7
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7
                  4
                  4
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  39
                  39
                  43
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2
                  6
                  6
               
               
                  1900
                  Budget authority (total)
                  41
                  45
                  49
               
               
                  1930
                  Total budgetary resources available
                  48
                  49
                  53
               
               
                  
                  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
                  9
                  12
                  12
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  44
                  45
                  49
               
               
                  3020
                  Outlays (gross)
                  â41
                  â45
                  â50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12
                  12
                  11
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  9
                  12
                  12
               
               
                  3200
                  Obligated balance, end of year
                  12
                  12
                  11
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  39
                  39
                  43
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  33
                  31
                  34
               
               
                  4011
                  Outlays from discretionary balances
                  4
                  3
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  37
                  34
                  43
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2
                  6
                  6
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  6
                  6
               
               
                  4101
                  Outlays from mandatory balances
                  4
                  5
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4
                  11
                  7
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â2
                  â6
                  â6
               
               
                  4180
                  Budget authority, net (total)
                  39
                  39
                  43
               
               
                  4190
                  Outlays, net (total)
                  39
                  39
                  44
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0135â0â1â751
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  16
                  17
                  20
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  18
                  21
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  7
                  7
               
               
                  21.0
                  Travel and transportation of persons
                  
                  
                  1
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  12
                  10
                  9
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  39
                  43
               
               
                  99.0
                  Reimbursable obligations
                  5
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  44
                  45
                  49
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  165
                  177
                  195
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  3
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         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, [$60,367,000] $82,000,000 shall be available from amounts available under section 241 of the PHS Act.  (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health information technology
                  60
                  60
                  
               
               
                  0002
                  Recovery Act activities
                  40
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  100
                  60
                  
               
               
                  0801
                  Office of the National Coordinator for Health Information Techno (Reimbursable)
                  19
                  22
                  22
               
               
                  0802
                  Reimbursable program activity: PHS Evaluation
                  
                  
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  19
                  22
                  104
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  119
                  82
                  104
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  3
                  3
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  43
                  3
                  3
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  60
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  PHS and Other
                  8
                  22
                  122
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  19
                  22
                  122
               
               
                  1900
                  Budget authority (total)
                  79
                  82
                  122
               
               
                  1930
                  Total budgetary resources available
                  122
                  85
                  125
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3
                  3
                  21
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  189
                  121
                  27
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  119
                  82
                  104
               
               
                  3011
                  Obligations incurred, expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â144
                  â176
                  â124
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â41
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  121
                  27
                  7
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â50
                  â31
                  â31
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â11
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â31
                  â31
                  â31
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  139
                  90
                  â4
               
               
                  3200
                  Obligated balance, end of year
                  90
                  â4
                  â24
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  79
                  82
                  122
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  46
                  70
                  104
               
               
                  4011
                  Outlays from discretionary balances
                  98
                  106
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  144
                  176
                  124
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â39
                  â22
                  â122
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â39
                  â22
                  â122
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â11
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  60
                  60
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  105
                  154
                  2
               
               
                  4180
                  Budget authority, net (total)
                  60
                  60
                  
               
               
                  4190
                  Outlays, net (total)
                  105
                  154
                  2
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0130â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  17
                  17
                  
               
               
                  11.3
                  Other than full-time permanent
                  
                  3
                  
               
               
                  11.5
                  Other personnel compensation
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  21
                  
               
               
                  12.1
                  Civilian personnel benefits
                  5
                  6
                  
               
               
                  21.0
                  Travel and transportation of persons
                  
                  1
                  
               
               
                  23.1
                  Rental payments to GSA
                  3
                  4
                  
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  1
                  1
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  17
                  14
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  13
                  12
                  
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  42
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  100
                  60
                  
               
               
                  99.0
                  Reimbursable obligations
                  19
                  22
                  104
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  119
                  82
                  104
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  158
                  198
                  198
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Office of medicare hearings and appealsFor expenses necessary for the Office of Medicare Hearings and Appeals, [$107,381,000] $120,000,000, 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Medicare Hearings and Appeals (Direct)
                  87
                  107
                  120
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  68
                  107
                  120
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  88
                  107
                  120
               
               
                  1930
                  Total budgetary resources available
                  88
                  108
                  121
               
               
                  
                  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
                  17
                  19
                  1
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  87
                  107
                  120
               
               
                  3020
                  Outlays (gross)
                  â84
                  â125
                  â120
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  19
                  1
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â19
                  â27
                  â27
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â20
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â27
                  â27
                  â27
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â2
                  â8
                  â26
               
               
                  3200
                  Obligated balance, end of year
                  â8
                  â26
                  â26
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  88
                  107
                  120
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  74
                  107
                  120
               
               
                  4011
                  Outlays from discretionary balances
                  10
                  18
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  84
                  125
                  120
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â80
                  â107
                  â120
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â20
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â8
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  4
                  18
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  4
                  18
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0139â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  46
                  57
                  60
               
               
                  12.1
                  Civilian personnel benefits
                  14
                  17
                  19
               
               
                  21.0
                  Travel and transportation of persons
                  
                  
                  1
               
               
                  22.0
                  Transportation of things
                  
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  7
                  9
                  10
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  4
                  3
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  5
                  6
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  8
                  11
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  4
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  5
               
               
                  26.0
                  Supplies and materials
                  1
                  
                  1
               
               
                  31.0
                  Equipment
                  1
                  2
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  87
                  107
                  120
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  526
                  642
                  749
               
               
                  
                     
                  
               
            
         
      
         Office of Medicare Hearings and Appeals                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  
                  130
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  130
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  130
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  130
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â130
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  130
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  130
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â130
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  50
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  18
               
               
                  22.0
                  Transportation of things
                  
                  
                  9
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  11
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  14
               
               
                  25.4
                  Operation and maintenance of facilities
                  
                  
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  4
               
               
                  26.0
                  Supplies and materials
                  
                  
                  1
               
               
                  31.0
                  Equipment
                  
                  
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  
                  
                  130
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  559
               
               
                  
                     
                  
               
            
         
      
         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, [$950,958,000] $956,108,000, of which $511,700,000 shall remain available through September 30, [2017] 2018, 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: 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, 2018] until expended: Provided further, That up to 10 percent of the amounts made available in this paragraph to support advanced
            research and development pursuant to section 319L of the PHS Act may also be used to supplement funds provided in the second
            paragraph for the purposes provided therein.
      
       For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act),  [$510,000,000] in addition to any other amounts available in the Special Reserve Fund, $350,000,000, to remain available until expended: Provided, That paragraphs (1) and (7)(C) of subsection (c) of section 319F-2 of the PHS Act, but no other provisions of
            such subsection, shall apply to such security countermeasures procured with funds made available under this heading: Provided
            further, That up to 10 percent of the amounts provided in this paragraph may also be used to supplement funds provided in
            the first paragraph to support advanced research and development pursuant to section 319L of the PHS Act.
      
      For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic or emerging infectious disease, including the development and purchase of vaccine, antivirals, necessary medical supplies, diagnostics, and other surveillance
            tools, [$72,000,000] $125,009,000; of which [$40,000,000] $111,000,000 shall be available until expended [, for activities including the development and purchase of vaccine, antivirals, necessary medical supplies, diagnostics, and
         other surveillance tools]: Provided, 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 to 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. (Department of Health and Human Services Appropriations Act, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Public Health and Social Services Emergency Fund
                  1,938
                  1,796
                  1,433
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct program activities, subtotal
                  1,938
                  1,796
                  1,433
               
               
                  0801
                  Reimbursable program (FEMA)
                  13
                  80
                  80
               
               
                  0802
                  Reimbursable program activity (OPP)
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  15
                  82
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,953
                  1,878
                  1,515
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  627
                  825
                  537
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0343]
                  â4
                  â1
                  â3
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0943]
                  â15
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  207
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  815
                  824
                  534
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,233
                  1,533
                  1,431
               
               
                  1100
                  Appropriation - Emergency Pursuant to 2011 BCA
                  733
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [075â0943]
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,951
                  1,533
                  1,431
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  5
                  82
                  82
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  14
                  82
                  82
               
               
                  1900
                  Budget authority (total)
                  1,965
                  1,615
                  1,513
               
               
                  1930
                  Total budgetary resources available
                  2,780
                  2,439
                  2,047
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  â24
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  825
                  537
                  532
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,095
                  4,051
                  3,550
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,953
                  1,878
                  1,515
               
               
                  3011
                  Obligations incurred, expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,769
                  â2,348
                  â1,931
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â207
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  â31
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,051
                  3,550
                  3,134
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â126
                  â82
                  â82
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  53
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â82
                  â82
                  â82
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3,969
                  3,969
                  3,468
               
               
                  3200
                  Obligated balance, end of year
                  3,969
                  3,468
                  3,052
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,965
                  1,615
                  1,513
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  258
                  490
                  486
               
               
                  4011
                  Outlays from discretionary balances
                  1,511
                  1,858
                  1,445
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,769
                  2,348
                  1,931
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â58
                  â82
                  â82
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â9
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  53
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  44
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  1,951
                  1,533
                  1,431
               
               
                  4080
                  Outlays, net (discretionary)
                  1,711
                  2,266
                  1,849
               
               
                  4180
                  Budget authority, net (total)
                  1,951
                  1,533
                  1,431
               
               
                  4190
                  Outlays, net (total)
                  1,711
                  2,266
                  1,849
               
               
                  
                     
                  
               
            
         
      
      
         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, Security and Strategic Information programs,
            and the Medical Reserve Corps.
         
         The PHSSEF continues to support the advanced development and procurement of biodefense and pandemic influenza countermeasures.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  75
                  76
                  78
               
               
                  11.3
                  Other than full-time permanent
                  6
                  6
                  6
               
               
                  11.7
                  Military personnel
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  88
                  89
                  91
               
               
                  12.1
                  Civilian personnel benefits
                  22
                  22
                  23
               
               
                  12.2
                  Military personnel benefits
                  3
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  4
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  17
                  17
                  17
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  24
                  24
                  24
               
               
                  25.1
                  Advisory and assistance services
                  349
                  275
                  206
               
               
                  25.2
                  Other services from non-Federal sources
                  140
                  140
                  108
               
               
                  25.3
                  Other goods and services from Federal sources
                  33
                  38
                  27
               
               
                  25.4
                  Operation and maintenance of facilities
                  20
                  22
                  20
               
               
                  25.5
                  Research and development contracts
                  487
                  436
                  289
               
               
                  25.7
                  Operation and maintenance of equipment
                  15
                  15
                  15
               
               
                  26.0
                  Supplies and materials
                  336
                  309
                  205
               
               
                  31.0
                  Equipment
                  16
                  17
                  16
               
               
                  41.0
                  Grants, subsidies, and contributions
                  382
                  383
                  383
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1,938
                  1,796
                  1,433
               
               
                  99.0
                  Reimbursable obligations
                  15
                  82
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,953
                  1,878
                  1,515
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  693
                  694
                  710
               
               
                  1101
                  Direct military average strength employment
                  82
                  74
                  74
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust Fund                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  AHRQ
                  107
                  94
                  106
               
               
                  0002
                  Office of the Secretary
                  22
                  24
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  129
                  118
                  132
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  69
                  52
                  52
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  70
                  52
                  52
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  111
                  118
                  132
               
               
                  1900
                  Budget authority (total)
                  111
                  118
                  132
               
               
                  1930
                  Total budgetary resources available
                  181
                  170
                  184
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  52
                  52
                  52
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  64
                  133
                  209
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  129
                  118
                  132
               
               
                  3020
                  Outlays (gross)
                  â59
                  â42
                  â101
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  133
                  209
                  240
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  64
                  133
                  209
               
               
                  3200
                  Obligated balance, end of year
                  133
                  209
                  240
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  111
                  118
                  132
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  4
                  4
               
               
                  4101
                  Outlays from mandatory balances
                  57
                  38
                  97
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  59
                  42
                  101
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â111
                  â118
                  â132
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â52
                  â76
                  â31
               
               
                  
                     
                  
               
            
         
      
      
         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 coordinate Federal health programs to 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 075â0145â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  21
                  19
                  21
               
               
                  25.3
                  Other goods and services from Federal sources
                  20
                  18
                  20
               
               
                  41.0
                  Grants, subsidies, and contributions
                  86
                  79
                  89
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  129
                  118
                  132
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Nonrecurring Expenses Fund                                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Nonrecurring Expenses Fund Projects
                  398
                  580
                  590
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  425
                  870
                  666
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  840
                  376
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,268
                  1,246
                  666
               
               
                  1930
                  Total budgetary resources available
                  1,268
                  1,246
                  666
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  870
                  666
                  76
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  372
                  350
                  464
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  398
                  580
                  590
               
               
                  3020
                  Outlays (gross)
                  â417
                  â466
                  â516
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  350
                  464
                  538
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  372
                  350
                  464
               
               
                  3200
                  Obligated balance, end of year
                  350
                  464
                  538
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  417
                  466
                  516
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  417
                  466
                  516
               
               
                  
                     
                  
               
            
         
      
      
         The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
            accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
            technology infrastructure.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  98
                  143
                  145
               
               
                  25.3
                  Other goods and services from Federal sources
                  300
                  437
                  445
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  398
                  580
                  590
               
               
                  
                     
                  
               
            
         
      
         Health Insurance Reform Implementation Fund                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0119â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health Insurance Reform Implementation Fund (Direct)
                  23
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  26
                  5
                  5
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  28
                  5
                  5
               
               
                  1930
                  Total budgetary resources available
                  28
                  5
                  5
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  5
                  5
                  5
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  88
                  32
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  23
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â76
                  â32
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  32
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  88
                  32
                  
               
               
                  3200
                  Obligated balance, end of year
                  32
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  76
                  32
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  76
                  32
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0119â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  23
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,000
                  1,000
                  1,000
               
               
                  1220
                  Appropriations transferred to other accts [075â0142]
                  â28
                  â28
                  â28
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â887
                  â892
                  â944
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  â12
                  â28
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â73
                  â68
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Affordable Care Act (P.L. 111â148), established the Prevention and Public Health Fund to support prevention and public
            health activities. In FY 2017, $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 075â0117â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pregnancy Assistance Fund (Direct)
                  23
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  25
                  25
                  25
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  23
                  23
                  25
               
               
                  1930
                  Total budgetary resources available
                  23
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  32
                  28
                  21
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  23
                  23
                  25
               
               
                  3020
                  Outlays (gross)
                  â24
                  â26
                  â26
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  â4
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  28
                  21
                  20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  32
                  28
                  21
               
               
                  3200
                  Obligated balance, end of year
                  28
                  21
                  20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  23
                  23
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  1
                  1
               
               
                  4101
                  Outlays from mandatory balances
                  22
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  24
                  26
                  26
               
               
                  4180
                  Budget authority, net (total)
                  23
                  23
                  25
               
               
                  4190
                  Outlays, net (total)
                  24
                  26
                  26
               
               
                  
                     
                  
               
            
         
      
      
         For awarding competitive grants to States to assist pregnant and parenting teens and women.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  22
                  22
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  23
                  23
                  25
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Section 241 Evaluation Transactions Account                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â3902â0â1â552
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Section 241 Evaluation Transactions Account (Reimbursable)
                  461
                  482
                  551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  461
                  482
                  551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.3)
                  461
                  482
                  551
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  93
                  482
                  551
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  368
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  461
                  482
                  551
               
               
                  1930
                  Total budgetary resources available
                  461
                  482
                  551
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  596
                  737
                  504
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  461
                  482
                  551
               
               
                  3020
                  Outlays (gross)
                  â320
                  â715
                  â784
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  737
                  504
                  271
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â630
                  â739
                  â739
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â368
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  259
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â739
                  â739
                  â739
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â34
                  â2
                  â235
               
               
                  3200
                  Obligated balance, end of year
                  â2
                  â235
                  â468
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  461
                  482
                  551
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  78
                  482
                  551
               
               
                  4011
                  Outlays from discretionary balances
                  242
                  233
                  233
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  320
                  715
                  784
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â352
                  â482
                  â551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â352
                  â482
                  â551
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â368
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  259
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â109
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â32
                  233
                  233
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â32
                  233
                  233
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health Service Act (PHS) Evaluation Transactions account supports the execution of section 241 of the PHS Act.
      
         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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Retirement payments
                  421
                  439
                  457
               
               
                  0002
                  Survivors' benefits
                  29
                  30
                  32
               
               
                  0003
                  Medical care
                  121
                  128
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  571
                  597
                  630
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  572
                  597
                  630
               
               
                  1930
                  Total budgetary resources available
                  572
                  597
                  630
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  66
                  71
                  35
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  571
                  597
                  630
               
               
                  3020
                  Outlays (gross)
                  â559
                  â633
                  â628
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  71
                  35
                  37
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  66
                  71
                  35
               
               
                  3200
                  Obligated balance, end of year
                  71
                  35
                  37
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  572
                  597
                  630
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  510
                  567
                  598
               
               
                  4101
                  Outlays from mandatory balances
                  49
                  66
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  559
                  633
                  628
               
               
                  4180
                  Budget authority, net (total)
                  572
                  597
                  630
               
               
                  4190
                  Outlays, net (total)
                  559
                  633
                  628
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2015
                     2016
                     2017
                  
                  
                     
                        
                     
                  
                  
                     Active Duty:
                     
                     
                     
                  
                  
                     HHS
                     4970
                     4964
                     4964
                  
                  
                     DOJ, BOP
                     878
                     879
                     879
                  
                  
                     Homeland Security
                     477
                     566
                     578
                  
                  
                     EPA
                     58
                     58
                     58
                  
                  
                     All Other
                     300
                     308
                     308
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Active Duty
                     6683
                     6775
                     6787
                  
                  
                     
                     
                     
                     
                  
                  
                     Retirees & Survivors:
                     
                     
                     
                  
                  
                     Retirees
                     6010
                     6130
                     6200
                  
                  
                     Retiree family members and survivors
                     1088
                     1097
                     1105
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Retirement Pay
                     7098
                     7227
                     7305
                  
                  
                     Total Beneficiaries (active duty, retirees, survivors)
                     13781
                     14002
                     14092
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         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 075â0379â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  13.0
                  Benefits for former personnel
                  450
                  469
                  489
               
               
                  25.6
                  Medical care
                  121
                  128
                  141
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  571
                  597
                  630
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0170â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  28
                  26
                  29
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  28
                  26
                  29
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  28
                  26
                  29
               
               
                  1930
                  Total budgetary resources available
                  28
                  26
                  29
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  28
                  26
                  29
               
               
                  3020
                  Outlays (gross)
                  â28
                  â26
                  â29
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  28
                  26
                  29
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  28
                  26
                  29
               
               
                  4180
                  Budget authority, net (total)
                  28
                  26
                  29
               
               
                  4190
                  Outlays, net (total)
                  28
                  26
                  29
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  28
                  26
                  29
               
               
                  
                  Outlays
                  28
                  26
                  29
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â2
               
               
                  
                  Outlays
                  
                  
                  â2
               
               
                  Total:
               
               
                  
                  Budget Authority
                  28
                  26
                  27
               
               
                  
                  Outlays
                  28
                  26
                  27
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0170â2â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â2
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  
                  
                  â2
               
               
                  3020
                  Outlays (gross)
                  
                  
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â2
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â2
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â2
               
               
                  
                     
                  
               
            
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9913â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  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
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         HHS Service and Supply Fund                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Program Support Center
                  781
                  765
                  801
               
               
                  0802
                  OS activities
                  441
                  425
                  426
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  1,222
                  1,190
                  1,227
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  130
                  116
                  116
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  187
                  116
                  116
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,095
                  1,190
                  1,227
               
               
                  1700
                  Collected from uncollected FY15 pmts - line 3090
                  
                  428
                  
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  56
                  â428
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,151
                  1,190
                  1,227
               
               
                  1930
                  Total budgetary resources available
                  1,338
                  1,306
                  1,343
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  116
                  116
                  116
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  621
                  790
                  
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  1,222
                  1,190
                  1,227
               
               
                  3020
                  Outlays (gross)
                  â996
                  â1,980
                  â1,227
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â57
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  790
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â372
                  â428
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â56
                  428
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â428
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  249
                  362
                  
               
               
                  3200
                  Obligated balance, end of year
                  362
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,151
                  1,190
                  1,227
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  619
                  1,190
                  1,227
               
               
                  4011
                  Outlays from discretionary balances
                  377
                  790
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  996
                  1,980
                  1,227
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â1,087
                  â1,190
                  â1,227
               
               
                  4030
                  Federal sources
                  
                  â428
                  
               
               
                  4033
                  Non-Federal sources
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,095
                  â1,618
                  â1,227
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â56
                  428
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â99
                  362
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â99
                  362
                  
               
               
                  
                     
                  
               
            
         
      
      
         The 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 the Secretary activities include the Service and Supply Fund Manager's Office, departmental
            contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
            small business consolidation, grants tracking, the physical security component 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 075â9941â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  105
                  107
                  107
               
               
                  11.3
                  Other than full-time permanent
                  5
                  5
                  5
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  7
                  7
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  120
                  122
                  122
               
               
                  12.1
                  Civilian personnel benefits
                  40
                  37
                  40
               
               
                  12.2
                  Military personnel benefits
                  4
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  2
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  27
                  22
                  22
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  12
                  9
                  9
               
               
                  24.0
                  Printing and reproduction
                  3
                  13
                  13
               
               
                  25.1
                  Advisory and assistance services
                  37
                  40
                  40
               
               
                  25.2
                  Other services from non-Federal sources
                  745
                  735
                  744
               
               
                  25.3
                  Other goods and services from Federal sources
                  77
                  71
                  96
               
               
                  25.4
                  Operation and maintenance of facilities
                  17
                  9
                  9
               
               
                  25.6
                  Medical care
                  24
                  29
                  29
               
               
                  25.7
                  Operation and maintenance of equipment
                  69
                  48
                  48
               
               
                  26.0
                  Supplies and materials
                  34
                  36
                  36
               
               
                  31.0
                  Equipment
                  9
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  1,222
                  1,190
                  1,227
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  998
                  1,110
                  1,168
               
               
                  2101
                  Reimbursable military average strength employment
                  76
                  65
                  65
               
               
                  3101
                  Allocation account military average strength employment
                  1,655
                  1,753
                  1,765
               
               
                  
                     
                  
               
            
         
      
      Trust Funds  
         Miscellaneous Trust Funds                                                                                                
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Contributions, Indian Health Facilities
                  65
                  48
                  48
               
               
                  1130
                  Contributions, N.I.H., Unconditional Gift Fund
                  4
                  3
                  3
               
               
                  1130
                  Centers for Disease Control, Gifts and Donations
                  22
                  15
                  15
               
               
                  1130
                  Contributions, N.I.H., Conditional Gift Fund
                  47
                  27
                  27
               
               
                  1130
                  Contributions to the Indian Health Service Gift Fund
                  
                  1
                  1
               
               
                  1140
                  Interest, Miscellaneous Trust Funds
                  1
                  
                  
               
               
                  1198
                  Rounding adjustment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  140
                  94
                  94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  140
                  94
                  94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  140
                  94
                  94
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Miscellaneous Trust Funds
                  â140
                  â94
                  â94
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Gifts
                  67
                  39
                  39
               
               
                  0003
                  Contributions, Indian Health Facilities
                  66
                  12
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  133
                  51
                  51
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  154
                  164
                  207
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  157
                  164
                  207
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  140
                  94
                  94
               
               
                  1930
                  Total budgetary resources available
                  297
                  258
                  301
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  164
                  207
                  250
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  76
                  93
                  80
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  133
                  51
                  51
               
               
                  3020
                  Outlays (gross)
                  â113
                  â64
                  â77
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  93
                  80
                  54
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  76
                  93
                  80
               
               
                  3200
                  Obligated balance, end of year
                  93
                  80
                  54
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  140
                  94
                  94
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6
                  9
                  9
               
               
                  4101
                  Outlays from mandatory balances
                  107
                  55
                  68
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  113
                  64
                  77
               
               
                  4180
                  Budget authority, net (total)
                  140
                  94
                  94
               
               
                  4190
                  Outlays, net (total)
                  113
                  64
                  77
               
               
                  
                     
                  
               
               
                  
                  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 075â9971â0â7â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  3
                  3
                  3
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  4
                  4
                  4
               
               
                  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
                  10
                  5
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  73
                  34
                  34
               
               
                  25.5
                  Research and development contracts
                  3
                  
                  
               
               
                  25.6
                  Medical care
                  1
                  
                  
               
               
                  26.0
                  Supplies and materials
                  4
                  
                  
               
               
                  31.0
                  Equipment
                  4
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  29
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  133
                  51
                  51
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2015 actual
                  2016 est.
                  2017 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, [$75,000,000] in addition to funds otherwise available for such purposes other than for Medicare and Medicaid oversight, $85,000,000: 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, 2016.)
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Inspector General (Direct)
                  75
                  77
                  85
               
               
                  0801
                  HCFAC Reimbursable program
                  190
                  199
                  203
               
               
                  0802
                  Direct Reimbursable program
                  16
                  21
                  21
               
               
                  0803
                  HCFAC Discretionary allocation adjustment
                  62
                  66
                  116
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  268
                  286
                  340
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations
                  343
                  363
                  425
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  22
                  32
                  34
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  5
                  13
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  22
                  32
                  34
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  71
                  75
                  85
               
               
                  1121
                  Appropriations transferred from other acct [075â9911]
                  2
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  73
                  77
                  85
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  62
                  67
                  122
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  21
                  21
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  83
                  88
                  143
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  163
                  200
                  213
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  35
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  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)
                  198
                  200
                  214
               
               
                  1900
                  Budget authority (total)
                  354
                  365
                  442
               
               
                  1930
                  Total budgetary resources available
                  376
                  397
                  476
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  32
                  34
                  51
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  33
                  50
                  53
               
               
                  3010
                  Obligations incurred, unexpired accounts
                  343
                  363
                  425
               
               
                  3020
                  Outlays (gross)
                  â325
                  â360
                  â451
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  50
                  53
                  27
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â60
                  â105
                  â126
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â56
                  â21
                  â21
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â105
                  â126
                  â147
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â27
                  â55
                  â73
               
               
                  3200
                  Obligated balance, end of year
                  â55
                  â73
                  â120
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  156
                  165
                  228
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  134
                  150
                  207
               
               
                  4011
                  Outlays from discretionary balances
                  17
                  10
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  151
                  160
                  224
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â72
                  â67
                  â122
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â21
                  â21
                  â21
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â11
                  â21
                  â21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  73
                  77
                  85
               
               
                  4080
                  Outlays, net (discretionary)
                  79
                  93
                  102
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  198
                  200
                  214
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  146
                  182
                  195
               
               
                  4101
                  Outlays from mandatory balances
                  28
                  18
                  32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  174
                  200
                  227
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â153
                  â188
                  â201
               
               
                  4123
                  Non-Federal sources
                  â10
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â163
                  â200
                  â213
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â35
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  
                  1
               
               
                  4170
                  Outlays, net (mandatory)
                  11
                  
                  14
               
               
                  4180
                  Budget authority, net (total)
                  73
                  77
                  86
               
               
                  4190
                  Outlays, net (total)
                  90
                  93
                  116
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â0128â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  39
                  40
                  46
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  41
                  42
                  48
               
               
                  12.1
                  Civilian personnel benefits
                  15
                  15
                  17
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  4
                  4
                  4
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  2
                  2
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  5
                  4
                  6
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  75
                  75
                  85
               
               
                  99.0
                  Reimbursable obligations
                  268
                  288
                  340
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations
                  343
                  363
                  425
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  345
                  358
                  400
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,179
                  1,258
                  1,430
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions                                                                                    
            
         
         GENERAL FUND RECEIPT ACCOUNTS                                                                                            
            
         (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2015 actual
                  2016 est.
                  2017 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  075â267410
                  Consumer Operated and Oriented Plan Direct Loan Program, Negative Subsidies
                  7
                  
                  
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                  6
                  3
                  
               
               
                  075â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                  122
                  34
                  34
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  34
                  90
                  90
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  689
                  639
                  631
               
               
                  Legislative proposal, subject to PAYGO
                  
                  
                  6
               
               
                  General Fund Offsetting receipts from the public
                  858
                  766
                  761
               
               
                  
                     
                  
               
               
                  
               
               
                  Intragovernmental payments:
               
               
                  075â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  173
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  173
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         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. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a discretionary grant or other extramural mechanism, at a rate in excess of Executive Level II.SEC. 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. 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. 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.SEC. 206. 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 [2016] 2017 under section 338B of such Act.SEC. 207. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. 208. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. 209. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
      Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
      Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
      provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.[SEC. 210. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.][SEC. 211. 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. [212]210. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year [2016] 2017:
      (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, construct, 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 Centers for Disease Control and Prevention may acquire, lease, construct, alter, renovate, equip, furnish, or manage facilities
               outside of the United States, as necessary to conduct such programs, in consultation with the Secretary of State, either directly
               for the use of the United States Government or for the use, pursuant to grants, direct assistance, or cooperative agreements,
               of public or nonprofit private institutions or agencies in participating foreign countries. 
      ([3]4) 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.
      '
      			
      (transfer of funds)SEC. [213]211. 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. [214]212. 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. [215]213. (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. [216]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. [217]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 sections 736,
      739, or 747 of the PHS Act, and 1 percent of the amount made available for NRSA shall be made available to the Director of
      the Agency for Healthcare Research and Quality to make NRSA awards for health service research.SEC. [218]216. In addition to amounts provided herein, payments made for research organisms or substances, authorized under section 301(a)
      of the PHS Act, shall be retained and credited to the appropriations accounts of the Institutes and Centers of the NIH making
      the substance or organism available under section 301(a). When such substances and organisms are made available through contractors, the Director may direct such contractors to collect
         such payments on behalf of the NIH and to forward amounts so collected to the NIH in the time and manner specified by the
         Director. Amounts credited to the account under this authority shall be available for obligation through September 30, [2017] 2018.SEC. [219]217. (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 sectionâ
         (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. 220. (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 through 2016, 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 shallâ
         (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. 221. (a) Within 45 days of enactment of this Act, the Secretary shall transfer funds appropriated under section 4002 of the 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).
      (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. 222. (a) The Secretary shall publish in the fiscal year 2017 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 ACA, and the amendments made by that Act, in the proposed fiscal year and
      each fiscal year since the enactment of the ACA.
      (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 whoâ
         (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; or
         (3) work on contracts for which FTE reporting is not a requirement of their contract, such as fixed-price contracts.]
      [SEC. 223. The Secretary shall publish, as part of the fiscal year 2017 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 Exchanges for each fiscal year since the enactment of the ACA and the proposed uses for
      such funds for fiscal year 2017. Such information shall include, for each such fiscal year, the amount of funds used for each
      activity specified under the heading "Health Insurance Exchange Transparency" in the explanatory statement described in section
      4 (in the matter preceding division A of this consolidated Act).][SEC. 224. (a) The Secretary shall provide to the Committees on Appropriations of the House of Representatives and the Senate:
      (1) Detailed monthly enrollment figures from the Exchanges established under the Patient Protection and Affordable Care Act of
         2010 pertaining to enrollments during the open enrollment period; and
      
      (2) Notification of any new or competitive grant awards, including supplements, authorized under section 330 of the Public Health
         Service Act.
      
      (b) The Committees on Appropriations of the House and Senate must be notified at least 2 business days in advance of any public
         release of enrollment information or the award of such grants.][SEC. 225. None of the funds made available by this Act from the Federal Hospital Insurance Trust Fund or the Federal Supplemental Medical
      Insurance Trust Fund, or transferred from other accounts funded by this Act to the "Centers for Medicare and Medicaid ServicesâProgram
      Management" account, may be used for payments under section 1342(b)(1) of Public Law 111â148 (relating to risk corridors).][SEC. 226. 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.]'
      			
      [(rescission)][SEC. 227. The following unobligated balances of amounts appropriated prior to fiscal year 2007 for "Department of Health and Human Services,
      Health Resources and Services Administration" are hereby permanently rescinded:
      (1) $281,003 appropriated to carry out section 1610(b) of the PHS Act;
      (2) $3,611 appropriated to carry out section 1602(c) of the PHS Act;
      (3) $105,576 appropriated in section 167 of division H of Public Law 108â199; and
      (4) $55,793 appropriated to carry out the National Cord Blood Stem Cell Bank Program.][SEC. 228. The Secretary shall include in the fiscal year 2017 budget justification an analysis of how section 2713 of the PHS Act will
      impact eligibility for discretionary HHS programs.][SEC. 229. Effective during the period beginning on November 1, 2015 and ending January 1, 2018, any provision of law that refers (including
      through cross-reference to another provision of law) to the current recommendations of the United States Preventive Services
      Task Force with respect to breast cancer screening, mammography, and prevention shall be administered by the Secretary involved
      as ifâ
      (1) such reference to such current recommendations were a reference to the recommendations of such Task Force with respect to
         breast cancer screening, mammography, and prevention last issued before 2009; and
      
      (2) such recommendations last issued before 2009 applied to any screening mammography modality under section 1861(jj) of the Social
         Security Act (42 U.S.C. 1395x(jj)).]'
      			
      (transfer of funds)SEC. [230]218. [(a) In general.âSubject to the succeeding provisions of this section, activities authorized under part A of title IV and section 1108(b)
      of the Social Security Act shall continue through September 30, 2016, in the manner authorized for fiscal year 2015, 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. Grants and payments may be made pursuant to this authority through September 30, 2016 at the
      level provided for such activities for fiscal year 2015, except as provided in subsection (b).]([b]a) Contingency fund.âIn the case of the Contingency Fund for State Welfare Programs established under section 403(b) of the Social Security Act[â], the amount appropriated for such section 403(b) shall be $608,000,000 for fiscal year 2018, to remain available until expended.[(1) the amount appropriated for such section 403(b) shall be $608,000,000 for each of fiscal years 2016 and 2017, notwithstanding
            section 228(b)(1) of the Department of Health and Human Services Appropriations Act, 2015;]
         [(2) the requirement to reserve funds provided for in section 403(b)(2) of the Social Security Act shall not apply during fiscal
            years 2016 and 2017; and]
         [(3) grants and payments may only be made from such Fund for fiscal year 2016 after the application of subsection (c).]
      
      ([c]b) Census research and welfare research.âOf the amount made available under [subsection (b)(1)] section 230(b)(1) of division H of Public Law 114â113 for section 403(b) of the Social Security Act for fiscal year [2016] 2017â
         (1) $15,000,000 is hereby transferred to the Children's Research and Technical Assistance account in the Administration for Children
            and Families at the Department of Health and Human Services and made available to carry out section 413(h) of the Social Security
            Act; and
         
         (2) $10,000,000 is hereby transferred and made available to the Bureau of the Census to conduct activities using the Survey of
            Income and Program Participation to obtain information to enable interested parties to evaluate the impact of the amendments
            made by title I of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
         
      [SEC. 231. Section 1886(m)(6) of the Social Security Act (42 U.S.C. 1395ww(m)(6)) is amendedâ
      (1) in subparagraph (A)(i) by striking "subparagraph (C)" and inserting "subparagraphs (C) and (E)"; and
      (2) by adding at the end the following new subparagraph:
         
            "(E) Temporary exception for certain severe wound discharges from certain long-term care hospitals.â
            "(i) In general.âIn the case of a discharge occurring prior to January 1, 2017, subparagraph (A)(i) shall not apply (and payment shall be
               made to a long-term care hospital without regard to this paragraph) if such dischargeâ
            
            "(I) is from a long-term care hospital that isâ
            "(aa) identified by the amendment made by section 4417(a) of the Balanced Budget Act of 1997 (42 U.S.C. 1395ww note, Public
               Law 105â33); and
            
            "(bb) located in a rural area (as defined in subsection (d)(2)(D)) or treated as being so located pursuant to subsection (d)(8)(E);
               and
            
            "(II) the individual discharged has a severe wound."(ii) Severe wound defined.âIn this subparagraph, the term 'severe wound' means a stage 3 wound, stage 4 wound, unstageable wound, non-healing surgical
            wound, infected wound, fistula, osteomyelitis, or wound with morbid obesity, as identified in the claim from the long-term
            care hospital.".]
      SEC. 219.   Section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)) is amended to read as followsâ 
         "(e) Fees for Conducting Revisit Surveys.âThe Secretary may impose fees upon facilities or entities referred to in this section
                  for conducting revisit surveys in cases where such facilities or entities have been cited for deficiencies during initial
                  certification, recertification, or substantiated complaint surveys. Such fees shall be established and collected in accordance
                  with regulations prescribed by the Secretary that provide for a gradual phase-in of the fee amounts, and collected funds shall
                  be available to supplement funding appropriated for such surveys. Fee amounts assessed upon an entity in an entity class shall
                  not exceed the estimated average cost of performing such surveys for an entity in such class. Such fees shall be collected
                  and available only to the extent and in such amounts as provided in advance in appropriations acts.".
      SEC. 220.   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 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. 221.  Section 1204(9) of the Omnibus Crime Control and Safe Streets Act of 1968 (42 U.S.C. 3796b(9)) is amendedâ (1)  in subparagraph (C)(ii) by striking "or";  
      (2)  in subparagraph (D), by striking the period and inserting "; or"; and 
      (3)  by adding at the end the following new subparagraph: 
      
         "(E) an intermittent disaster-response appointee of the National Disaster Medical System under section 2812 of the Public
                  Health Service Act (42 U.S.C. 300hh-11) who is performing official duties of the Service, if those official duties are determined
                  by the Secretary of Health and Human Services to be hazardous duties.".
      SEC. 222.  In the event of a public health emergency declared under section 319 of the PHS Act, the Secretary may, during the duration
            of the emergency, transfer discretionary funds (as defined pursuant to the Balanced Budget and Emergency Deficit Control Act
            of 1985) which are appropriated in this Act for the current fiscal year for the Department of Health and Human Services between
            appropriations for costs of responding to and aiding in recovery from such public health emergency: Provided, That no appropriation
            may be reduced by more than 10 percent under this section: Provided further, That the Committees on Appropriations of the
            House of Representatives and the Senate shall be promptly notified of such transfers: Provided further, That this transfer
            authority is in addition to any other transfer authority.  SEC. 223.  Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended by adding at the end the following new subsection: "(f) The Secretary may issue regulations with binding and future effect for the program authorized by this section.".SEC. 224. (a)  In General.âUnder the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
            the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
            within the Department or of another agency under whichâ (1)  the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
               or cooperative agreement on behalf of the ordering agency or unit; 
      (2)  the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
               and 
      (3)  the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
               and for the service of executing or managing the grant or cooperative agreement. 
      (b)  Conditions.âThe conditions for making an agreement described in subsection (a) are thatâ (1)  amounts are available; 
         (2)  the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and 
         (3)  the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service. 
      
      (c)  Payment.âPayment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
               agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
               any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
               request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
               shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
               and the actual cost of service provided. 
      (d)  Limitations on Funds.âA condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
               agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement. 
      (e)  Obligation of Appropriations.âAn agreement made under this section obligates an appropriation of the ordering agency or unit.
               The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
               before the end of the period of availability of the appropriation, inâ (1)  awarding the grant or cooperative agreement; or 
         (2)  providing the agreed-on services. 
      
      (f)  No Effect on Other LawsâThis section does not affect other laws about reimbursable agreements. SEC. 225.  Notwithstanding subparagraph (B)(i) of section 303(g)(2) of the Controlled Substances Act (21 U.S.C. 823(g)(2)), the Secretary
            of Health and Human Services may, using amounts made available in this Act to carry out title V of the Public Health Service
            Act, establish and carry out a demonstration through fiscal year 2021 in which, for purposes of prescribing buprenorphine
            under such section 303(g)(2), the term "practitioner" shall be deemed to include non-physician providers authorized to prescribe
            buprenorphine by the jurisdiction in which the provider is licensed who meet such criteria as determined appropriate by the
            Secretary, in consultation with the Attorney General, for participation in the project. In implementing this demonstration
            project, the Secretary and Attorney General shall not be subject to the requirements of 5 U.S.C. 553. The Secretary may enter
            into grants, contracts, or cooperative agreements with one or more research institutions, and public and nonprofit entities
            to assist in carrying out such demonstration. In addition, amounts available for this fiscal year in other Acts to the Attorney
            General for carrying out section 303 of the Controlled Substances Act shall also be available to the Attorney General to facilitate
            and support the efficient operation of the demonstration under this section. Any authority for a provider to prescribe buprenorphine
            that results from participating in this demonstration project shall end no later than the date such provider ceases to participate
            in this demonstration.  (Department of Health and Human Services Appropriations Act, 2016.)