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

             <h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES

             </h1>

          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 92–313 for programs and activities of the Food and Drug Administration
                which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
                and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
                on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $2,527,960,000: Provided, That of the amount provided under this heading, $24,142,000 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; $12,100,000 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; $672,000,000 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  animal drug user fees and animal generic drug user fees that exceed the respective fiscal year 2018 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from  animal drug and animal generic drug assessments for fiscal year 2018, including any such fees collected prior to fiscal year 2018 but credited for fiscal year 2018, shall be subject to the fiscal year 2018 limitations: Provided further, That the Secretary may accept payment during fiscal year 2018 of user fees specified under this heading and authorized for fiscal year 2019, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2019 for which the Secretary accepts payment in fiscal year 2018 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 not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided
                for, as determined by the Commissioner: Provided further, That funds may be transferred from one specified activity to another with the prior 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), third-party logistics provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C. 384d(c)(8), and Medical Countermeasure Priority Review Voucher User Fees authorized by 21 U.S.C. 360bbb-4a, shall be credited to this account, to remain available until expended.

             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,
                $8,771,000, to remain available until expended.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2016 actual
                      2017 est.
                      2018 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
                      –2
                      –2
                      –2

                      5099
                      Balance, end of year
                      1
                      2
                      3

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Foods
                      1,002
                      985
                      910

                      0002
                      Human Drugs
                      491
                      491
                      179

                      0003
                      Devices and Radiological Health
                      323
                      323
                      140

                      0004
                      National Center for Toxicological Research
                      63
                      63
                      60

                      0005
                      FDA Other Activities (FDA Headquaters)
                      182
                      183
                      125

                      0006
                      FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)
                      121
                      121
                      73

                      0007
                      FDA GSA Rental Payments
                      162
                      176
                      128

                      0008
                      FDA Buildings and Facilities
                      8
                      9
                      9

                      0009
                      Cooperative Research and Development (CRADA)
                      2
                      2
                      2

                      0010
                      Animal Drugs and Feed
                      159
                      158
                      108

                      0011
                      Biologics
                      215
                      215
                      96

                      0012
                      Food and Drug Safety (no-year)
                      2

                      0013
                      Ebola (Emergency pursuant to 2011 BCA)
                      9

                      0014
                      Zika Activities
                      2

                      0015
                      CURES Act

                      20
                      60

                      0799
                      Total direct obligations
                      2,741
                      2,746
                      1,890

                      0801
                      FDA Reimbursable program (User fees)
                      1,930
                      1,908
                      757

                      0802
                      FDA Reimbursable program (Federal sources)
                      40

                      0899
                      Total reimbursable obligations
                      1,970
                      1,908
                      757

                      0900
                      Total new obligations, unexpired accounts
                      4,711
                      4,654
                      2,647

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      948
                      1,117
                      1,116

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      948
                      1,117

                      1021
                      Recoveries of prior year unpaid obligations
                      17

                      1050
                      Unobligated balance (total)
                      965
                      1,117
                      1,116

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,730
                      2,724
                      1,828

                      1120
                      Appropriations transferred to other accts [075–0128]
                      –2
                      –1

                      1121
                      Appropriations transferred from other acct [075–5629]

                      20
                      60

                      1160
                      Appropriation, discretionary (total)
                      2,728
                      2,743
                      1,888

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      2
                      2
                      2

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      2,108
                      1,908
                      761

                      1700
                      Collected

                      33

                      1701
                      Change in uncollected payments, Federal sources
                      33
                      –33

                      1702
                      Offsetting collections (previously unavailable)
                      615
                      333

                      1723
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced

                      –4

                      1725
                      Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                      –620
                      –333

                      1750
                      Spending auth from offsetting collections, disc (total)
                      2,136
                      1,904
                      761

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1
                      4

                      1801
                      Change in uncollected payments, Federal sources
                      4

                      1850
                      Spending auth from offsetting collections, mand (total)
                      5
                      4

                      1900
                      Budget authority (total)
                      4,871
                      4,653
                      2,651

                      1930
                      Total budgetary resources available
                      5,836
                      5,770
                      3,767

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –8

                      1941
                      Unexpired unobligated balance, end of year
                      1,117
                      1,116
                      1,120

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      2,781
                      2,710
                      2,721

                      3010
                      New obligations, unexpired accounts
                      4,711
                      4,654
                      2,647

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      20

                      3020
                      Outlays (gross)
                      –4,693
                      –4,643
                      –2,840

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –17

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –92

                      3050
                      Unpaid obligations, end of year
                      2,710
                      2,721
                      2,528

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –59
                      –71
                      –38

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –37
                      33

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      25

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –71
                      –38
                      –38

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2,722
                      2,639
                      2,683

                      3200
                      Obligated balance, end of year
                      2,639
                      2,683
                      2,490

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,864
                      4,647
                      2,649

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,654
                      3,631
                      1,967

                      4011
                      Outlays from discretionary balances
                      2,032
                      1,006
                      871

                      4020
                      Outlays, gross (total)
                      4,686
                      4,637
                      2,838

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –28
                      –33

                      4033
                      Non-Federal sources
                      –2,098
                      –1,908
                      –761

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –2,126
                      –1,941
                      –761

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –33
                      33

                      4052
                      Offsetting collections credited to expired accounts
                      18

                      4060
                      Additional offsets against budget authority only (total)
                      –15
                      33

                      4070
                      Budget authority, net (discretionary)
                      2,723
                      2,739
                      1,888

                      4080
                      Outlays, net (discretionary)
                      2,560
                      2,696
                      2,077

                      Mandatory:

                      4090
                      Budget authority, gross
                      7
                      6
                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      5
                      6
                      2

                      4101
                      Outlays from mandatory balances
                      2

                      4110
                      Outlays, gross (total)
                      7
                      6
                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –4

                      4123
                      Non-Federal sources
                      –1

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –1
                      –4

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –4

                      4160
                      Budget authority, net (mandatory)
                      2
                      2
                      2

                      4170
                      Outlays, net (mandatory)
                      6
                      2
                      2

                      4180
                      Budget authority, net (total)
                      2,725
                      2,741
                      1,890

                      4190
                      Outlays, net (total)
                      2,566
                      2,698
                      2,079

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      638
                      643
                      647

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      643
                      647
                      647

             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 2018 Budget provides funding to support food and medical
                product safety, including implementation of the 21st Century Cures Act. The budget also includes a package of administrative
                actions designed to achieve regulatory efficiency and speed the development of safe and effective medical products.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      910
                      886
                      613

                      11.3
                      Other than full-time permanent
                      92
                      90
                      62

                      11.5
                      Other personnel compensation
                      40
                      39
                      27

                      11.7
                      Military personnel
                      64
                      63
                      64

                      11.8
                      Special personal services payments
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      1,107
                      1,079
                      767

                      12.1
                      Civilian personnel benefits
                      338
                      330
                      228

                      12.2
                      Military personnel benefits
                      33
                      32
                      33

                      13.0
                      Benefits for former personnel
                      1

                      21.0
                      Travel and transportation of persons
                      50
                      51
                      33

                      22.0
                      Transportation of things
                      3
                      3
                      2

                      23.1
                      Rental payments to GSA
                      162
                      176
                      128

                      23.2
                      Rental payments to others
                      3
                      3
                      2

                      23.3
                      Communications, utilities, and miscellaneous charges
                      19
                      19
                      12

                      24.0
                      Printing and reproduction
                      2
                      2
                      1

                      25.1
                      Advisory and assistance services
                      57
                      55
                      36

                      25.2
                      Other services from non-Federal sources
                      361
                      372
                      242

                      25.3
                      Other goods and services from Federal sources
                      135
                      139
                      91

                      25.4
                      Operation and maintenance of facilities
                      104
                      108
                      70

                      25.5
                      Research and development contracts
                      20
                      20
                      13

                      25.7
                      Operation and maintenance of equipment
                      91
                      94
                      61

                      26.0
                      Supplies and materials
                      47
                      48
                      31

                      31.0
                      Equipment
                      47
                      48
                      31

                      32.0
                      Land and structures
                      3
                      3
                      2

                      41.0
                      Grants, subsidies, and contributions
                      156
                      162
                      105

                      42.0
                      Insurance claims and indemnities
                      2
                      2
                      2

                      99.0
                      Direct obligations
                      2,741
                      2,746
                      1,890

                      99.0
                      Reimbursable obligations
                      1,970
                      1,908
                      757

                      99.9
                      Total new obligations, unexpired accounts
                      4,711
                      4,654
                      2,647

          Employment Summary

                      Identification code 075–9911–0–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      9,605
                      9,768
                      6,663

                      1101
                      Direct military average strength employment
                      692
                      703
                      703

                      2001
                      Reimbursable civilian full-time equivalent employment
                      5,737
                      6,163
                      1,292

                      2101
                      Reimbursable military average strength employment
                      413
                      420
                      56

                      3001
                      Allocation account civilian full-time equivalent employment
                      43
                      43
                      43

                      3101
                      Allocation account military average strength employment
                      1
                      1
                      1

             Salaries and Expenses
             (Legislative proposal, not subject to PAYGO)Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for prescription drug review activities,
                   medical device review activities, biosimilar biological products review activities, and human generic drugs review activities:
                   Provided, That fees of $1,262,182,000, for prescription drug reviews, shall be credited to this account and remain available
                   until expended; $439,001,000 for medical device reviews, shall be credited to this account and remain available until expended;
                   $615,746,000 for human generic drug reviews, shall be credited to this account and remain available until expended; and $86,736,000
                   for biosimilar biological product reviews, shall be credited to this account and remain available until expended: Provided
                   further, That, in addition and notwithstanding any other provision under this heading, amounts collected for prescription
                   drug user fees, medical device user fees, biosimilar biological product user fees, and human generic drug user fees that exceed
                   the respective fiscal year 2018 limitations are appropriated and shall be credited to this account and remain available until
                   expended: Provided further, That fees derived from prescription drug reviews, medical device reviews, biosimilar biological
                   products reviews, and human generic drugs reviews for fiscal year 2018 received during fiscal year 2018, including any such
                   fees assessed prior to fiscal year 2018 but credited for fiscal year 2018, shall be subject to the fiscal year 2018 limitations:
                   Provided further, That the Secretary may accept payment during fiscal year 2018 of user fees specified in this paragraph and
                   authorized for fiscal year 2019, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year
                   2019 for which the Secretary accepts payment in fiscal year 2018 shall not be included in amounts in this paragraph.
           In addition, contingent upon the enactment of authorizing legislation, the Secretary shall increase the fees for animal drug
                   review activities and animal generic drug review activities: Provided, That additional fees of $46,110,000, for animal drug
                   reviews, shall be credited to this account and remain available until expended; and $6,375,000, for animal generic drug reviews,
                   shall be credited to this account and remain available until expended.

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Reimbursable program (User fees)

                      2,458

                      0899
                      Total reimbursable obligations

                      2,458

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected

                      2,458

                      1900
                      Budget authority (total)

                      2,458

                      1930
                      Total budgetary resources available

                      2,458

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      2,458

                      3020
                      Outlays (gross)

                      –2,458

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      2,458

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      2,458

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources

                      –2,458

                      4040
                      Offsets against gross budget authority  and outlays (total)

                      –2,458

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

              The FY 2018 Budget includes proposals to reauthorize expiring fee programs and amend currently authorized fee programs. The
                Budget includes a total of $1.3 billion in prescription drug fees, $439 million in medical device fees, $616 million in human
                generic drug fees, and $87 million in biosimilar user fees. The proposed legislation authorizes the collection and spending
                of these fees subject to appropriations. FDA also proposes to increase animal drug user fees by $46 million and animal generic
                drug user fees by $7 million in their final year of authorization.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      720

                      11.3
                      Other than full-time permanent

                      102

                      11.5
                      Other personnel compensation

                      77

                      11.7
                      Military personnel

                      32

                      11.9
                      Total personnel compensation

                      931

                      12.1
                      Civilian personnel benefits

                      278

                      12.2
                      Military personnel benefits

                      18

                      21.0
                      Travel and transportation of persons

                      16

                      23.1
                      Rental payments to GSA

                      92

                      23.3
                      Communications, utilities, and miscellaneous charges

                      4

                      24.0
                      Printing and reproduction

                      3

                      25.1
                      Advisory and assistance services

                      74

                      25.2
                      Other services from non-Federal sources

                      467

                      25.3
                      Other goods and services from Federal sources

                      262

                      25.4
                      Operation and maintenance of facilities

                      31

                      25.5
                      Research and development contracts

                      18

                      25.7
                      Operation and maintenance of equipment

                      44

                      26.0
                      Supplies and materials

                      17

                      31.0
                      Equipment

                      27

                      41.0
                      Grants, subsidies, and contributions

                      176

                      99.0
                      Reimbursable obligations

                      2,458

                      99.9
                      Total new obligations, unexpired accounts

                      2,458

          Employment Summary

                      Identification code 075–9911–2–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      2001
                      Reimbursable civilian full-time equivalent employment

                      8,456

                      2101
                      Reimbursable military average strength employment

                      364

             Payment to the FDA Innovation Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0148–0–1–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Direct program activity

                      20
                      60

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)

                      20
                      60

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      20
                      60

                      1930
                      Total budgetary resources available

                      20
                      60

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      20
                      60

                      3020
                      Outlays (gross)

                      –20
                      –60

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      20
                      60

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      20
                      60

                      4180
                      Budget authority, net (total)

                      20
                      60

                      4190
                      Outlays, net (total)

                      20
                      60

             This account, and a related special receipt account, were established to support the execution structure necessary to implement
                the 21st Century Cures Act.

             FDA Innovation, CURES Act For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
                   to amounts available for such purposes under the heading "Salaries and Expenses", $60,000,000, to remain available until expended:
                   Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century
                   Cures Act, are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the
                   Secretary of Health and Human Services to other accounts of the Department solely for the purposes provided in such Act: Provided
                   further, That such transfer authority is in addition to any other transfer authority provided by law.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, FDA Innovation, CURES Act

                      20
                      60

                      2000
                      Total: Balances and receipts

                      20
                      60

                      Appropriations:

                      Current law:

                      2101
                      FDA Innovation, Cures Act

                      –20
                      –60

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)

                      20
                      60

                      1120
                      Appropriations transferred to other acct [075–9911]

                      –20
                      –60

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The 21st Century Cures Act was enacted into law on December 13, 2016. The Act includes authorities FDA can use to help modernize
                drug, biological, and device product development and review, and to create greater efficiencies and predictability in product
                development and review.

             Revolving Fund for Certification and Other Services

             Program and Financing (in millions of dollars)

                      Identification code 075–4309–0–3–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Revolving Fund for Certification and Other Services (Reimbursable)
                      9
                      10
                      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
                      9
                      10
                      9

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –1
                      –1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      9
                      10
                      10

                      1900
                      Budget authority (total)
                      9
                      10
                      10

                      1930
                      Total budgetary resources available
                      14
                      15
                      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
                      2
                      2

                      3010
                      New obligations, unexpired accounts
                      9
                      10
                      10

                      3020
                      Outlays (gross)
                      –9
                      –10
                      –10

                      3050
                      Unpaid obligations, end of year
                      2
                      2
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2
                      2
                      2

                      3200
                      Obligated balance, end of year
                      2
                      2
                      2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      9
                      10
                      10

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3
                      10
                      10

                      4101
                      Outlays from mandatory balances
                      6

                      4110
                      Outlays, gross (total)
                      9
                      10
                      10

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –9
                      –10
                      –9

                      4180
                      Budget authority, net (total)

                      1

                      4190
                      Outlays, net (total)

                      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 075–4309–0–3–554
                      2016 actual
                      2017 est.
                      2018 est.

                      Reimbursable obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      4
                      5
                      5

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      1
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      9
                      10
                      10

          Employment Summary

                      Identification code 075–4309–0–3–554
                      2016 actual
                      2017 est.
                      2018 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      36
                      36
                      36

             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, $1,488,687,000: Provided, That no more than $100,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,703,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of section 224 of the PHS Act, and for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative
                claims made under such law.

             Health workforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E  and 1921(b) of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $382,631,000: Provided, That sections 751 and 762(k) of the PHS Act shall not apply to funds made available under this heading:  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, $795,290,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $76,946,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2)
                of such Act and $10,256,000 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, $2,260,008,000, of which $1,967,134,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through September 30, 2020, for parts A and B of title XXVI of the PHS Act, and of which not less than $898,602,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That section 2691 of the PHS Act shall not apply to funds appropriated under this heading.

             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, $99,351,000.

             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 section 711 of the Social Security Act, $74,395,000.

             Family PlanningFor carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $286,479,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling
                shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution
                of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for
                public office.

             program managementFor program support in the Health Resources and Services Administration, $151,993,000: 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".
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0005
                      Primary Health Care (Health Centers, Free Clinics)
                      1,492
                      1,489
                      1,489

                      0010
                      Primary Health Care (Mandatory)
                      3,651
                      3,607
                      2

                      0015
                      Health Workforce
                      785
                      785
                      383

                      0020
                      Health Workforce (Mandatory)
                      368
                      367

                      0025
                      Maternal and Child Health
                      843
                      859
                      795

                      0030
                      Maternal and Child Health (Mandatory)
                      5
                      5

                      0035
                      Ryan White HIV/AIDS
                      2,266
                      2,396
                      2,260

                      0040
                      Health Care Systems
                      103
                      103
                      99

                      0045
                      Rural Health
                      151
                      149
                      74

                      0050
                      Family Planning
                      286
                      286
                      286

                      0055
                      HRSA Program Management
                      154
                      154
                      152

                      0300
                      Total direct programs
                      10,104
                      10,200
                      5,540

                      0799
                      Total direct obligations
                      10,104
                      10,200
                      5,540

                      0801
                      Health Resources and Services (Reimbursable)
                      57
                      58
                      47

                      0899
                      Total reimbursable obligations
                      57
                      58
                      47

                      0900
                      Total new obligations, unexpired accounts
                      10,161
                      10,258
                      5,587

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      406
                      482
                      273

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      141
                      211

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      2

                      1021
                      Recoveries of prior year unpaid obligations
                      80

                      1031
                      Other balances not available
                      –1

                      1050
                      Unobligated balance (total)
                      488
                      482
                      273

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      6,140
                      6,143
                      5,539

                      1120
                      Appropriations transferred to other acct [075–0140]
                      –7

                      1160
                      Appropriation, discretionary (total)
                      6,133
                      6,143
                      5,539

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3,975
                      3,975

                      1220
                      Appropriations transferred to other acct [015–5606]
                      –5
                      –5

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      –115

                      1260
                      Appropriations, mandatory (total)
                      3,970
                      3,855

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      24
                      31
                      26

                      1701
                      Change in uncollected payments, Federal sources
                      12

                      1750
                      Spending auth from offsetting collections, disc (total)
                      36
                      31
                      26

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Offsetting collections (cash)(HPSL&NSL)
                      24
                      19
                      19

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      2
                      1

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –2
                      –1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      23
                      20
                      20

                      1900
                      Budget authority (total)
                      10,162
                      10,049
                      5,585

                      1930
                      Total budgetary resources available
                      10,650
                      10,531
                      5,858

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –7

                      1941
                      Unexpired unobligated balance, end of year
                      482
                      273
                      271

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,399
                      7,701
                      8,229

                      3010
                      New obligations, unexpired accounts
                      10,161
                      10,258
                      5,587

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      19

                      3020
                      Outlays (gross)
                      –9,674
                      –9,730
                      –8,623

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –80

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –124

                      3050
                      Unpaid obligations, end of year
                      7,701
                      8,229
                      5,193

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –36
                      –22
                      –22

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –12

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      26

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –22
                      –22
                      –22

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,363
                      7,679
                      8,207

                      3200
                      Obligated balance, end of year
                      7,679
                      8,207
                      5,171

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      6,169
                      6,174
                      5,565

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,938
                      1,953
                      1,733

                      4011
                      Outlays from discretionary balances
                      3,987
                      3,993
                      4,265

                      4020
                      Outlays, gross (total)
                      5,925
                      5,946
                      5,998

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –27
                      –13
                      –8

                      4033
                      Non-Federal sources
                      –23
                      –18
                      –18

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –50
                      –31
                      –26

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –12

                      4052
                      Offsetting collections credited to expired accounts
                      26

                      4060
                      Additional offsets against budget authority only (total)
                      14

                      4070
                      Budget authority, net (discretionary)
                      6,133
                      6,143
                      5,539

                      4080
                      Outlays, net (discretionary)
                      5,875
                      5,915
                      5,972

                      Mandatory:

                      4090
                      Budget authority, gross
                      3,993
                      3,875
                      20

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,480
                      1,537
                      20

                      4101
                      Outlays from mandatory balances
                      2,269
                      2,247
                      2,605

                      4110
                      Outlays, gross (total)
                      3,749
                      3,784
                      2,625

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –24
                      –19
                      –19

                      4180
                      Budget authority, net (total)
                      10,102
                      9,999
                      5,540

                      4190
                      Outlays, net (total)
                      9,600
                      9,680
                      8,578

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      1
                      2
                      1

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      2
                      1

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      10,102
                      9,999
                      5,540

                      Outlays
                      9,600
                      9,680
                      8,578

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      3,970

                      Outlays

                      1,561

                      Total:

                      Budget Authority
                      10,102
                      9,999
                      9,510

                      Outlays
                      9,600
                      9,680
                      10,139

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

                      Identification code 075–0350–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Guaranteed loan levels supportable by subsidy budget authority:

                      215001
                      Health centers: Facilities renovation loan guarantee levels
                      9
                      3
                      3

                      215999
                      Total loan guarantee levels
                      9
                      3
                      3

                      Guaranteed loan subsidy (in percent):

                      232001
                      Health centers: Facilities renovation loan guarantee levels
                      2.67
                      2.65
                      2.69

                      232999
                      Weighted average subsidy rate
                      2.67
                      2.65
                      2.69

                      Guaranteed loan reestimates:

                      235001
                      Health centers: Facilities renovation loan guarantee levels

                      –1

                      235999
                      Total guaranteed loan reestimates

                      –1

             Resources displayed here support 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.

             HRSA Program Activity Crosswalk FY 2018 President's Budget to FY 2017 President's Budget Dollars in Millions

                         FY 2018 Program Activities
                         FY 2017 Program Activities
                         FY 2016 Obligations
                         FY 2017 Obligations
                         FY 2018 Obligations

                         0005 Primary Health Care (Health Centers, Free Clinics)

                         1,492
                         1,489
                         1,489

                         Health Centers
                         1,390
                         1,389
                         1,389

                         Free Clinics Medical Malpractice
                         0
                         0
                         0

                         Health Centers Tort Claims
                         102
                         100
                         100

                         0010 Primary Health Care (Health Centers Mandatory)

                         3,651
                         3,607
                         2

                         Health Centers ACA
                         3,650
                         3,605
                         0

                         School Based Health Centers ACA
                         1
                         2
                         2

                         0015 Health Workforce

                         785
                         785
                         383

                         Health Workforce
                         407
                         407
                         5

                         Children's Hospital Graduate Medical Education
                         294
                         294
                         295

                         NURSE Corps Scholarship and Loan Repayment Program
                         83
                         83
                         83

                         Loan Repayment/Faculty Fellowships
                         1
                         1
                         0

                         0020 Health Workforce Mandatory

                         368
                         367
                         0

                         National Health Service Corps ACA
                         308
                         311
                         0

                         GME Payments THC ACA
                         60
                         56
                         0

                         0025 Maternal and Child Health

                         843
                         859
                         795

                         Maternal and Child Health Block Grant
                         637
                         637
                         667

                         Healthy Start
                         103
                         119
                         128

                         Emergency Medical Services for Children
                         20
                         20
                         0

                         James T. Walsh Universal Newborn Hearing Screening
                         18
                         18
                         0

                         Heritable Disorders
                         14
                         14
                         0

                         Autism and Other Developmental Disorders
                         47
                         47
                         0

                         Sickle Cell Service Demonstrations
                         4
                         4
                         0

                         0030 Maternal and Child Health Mandatory

                         5
                         5
                         0

                         Family to Family Health Information Centers ACA
                         5
                         5
                         0

                         0035 Ryan White HIV/AIDS

                         2,266
                         2,396
                         2,260

                         HIV/AIDS
                         2,266
                         2,396
                         2,260

                         0040 Health Care Systems

                         103
                         103
                         99

                         Organ Transplantation
                         24
                         24
                         24

                         C.W. Bill Young Cell Transplantation Program
                         22
                         22
                         22

                         Poison Control Centers
                         19
                         19
                         19

                         Hansen's Disease Center
                         15
                         15
                         11

                         Payment to Hawaii for the Treatment of Hansen's Disease
                         2
                         2
                         2

                         National Cord Blood Inventory
                         11
                         11
                         11

                         340 B Drug Pricing Program/Office of Pharmacy Affairs
                         10
                         10
                         10

                         0045 Rural Health

                         151
                         149
                         74

                         Rural Health Outreach Grants
                         64
                         63
                         50

                         Rural Hospital Flexibility Grants
                         42
                         42
                         0

                         Telehealth
                         17
                         17
                         10

                         State Offices of Rural Health
                         10
                         9
                         0

                         Rural Health Policy Development
                         9
                         9
                         5

                         Black Lung Clinics
                         7
                         7
                         7

                         Radiation Exposure Screening and Education Program
                         2
                         2
                         2

                         0050 Family Planning

                         286
                         286
                         286

                         Family Planning
                         286
                         286
                         286

                         0055 HRSA Program Management

                         154
                         154
                         152

                         Program Management
                         154
                         154
                         152

                         0801 Health Resources and Services (Reimbursable)

                         57
                         58
                         47

                         Health Resources and Services (Reimbursable)

                         0
                         0

                         0802 HRSA reimbursable program: PHS evaluation

                         0
                         0
                         0

                         Reimbursable program: PHS evaluation
                         0
                         0
                         0

             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 2015–2016 data reported in the Annual Operating Report.

             Health Professions Revolving Loan Programs Federal Capital Contribution

                         Program
                         Account Balance

                         HPSL
                         412,794,283

                         NSL
                         186,799,617

                         PCL
                         247,553,867

                         LDS
                         154,323,482

                         Total
                         1,001,471,249

          Object Classification (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      177
                      199
                      146

                      11.3
                      Other than full-time permanent
                      8
                      8
                      5

                      11.5
                      Other personnel compensation
                      3
                      3
                      2

                      11.7
                      Military personnel
                      19
                      20
                      15

                      11.9
                      Total personnel compensation
                      207
                      230
                      168

                      12.1
                      Civilian personnel benefits
                      58
                      64
                      47

                      12.2
                      Military personnel benefits
                      11
                      11
                      9

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      2

                      23.1
                      Rental payments to GSA
                      28
                      28
                      23

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      7
                      7
                      5

                      25.1
                      Advisory and assistance services
                      10
                      10
                      7

                      25.2
                      Other services from non-Federal sources
                      238
                      240
                      187

                      25.3
                      Other goods and services from Federal sources
                      292
                      278
                      152

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.6
                      Medical care
                      3
                      3

                      25.7
                      Operation and maintenance of equipment
                      4
                      4
                      3

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      9
                      9
                      6

                      41.0
                      Grants, subsidies, and contributions
                      9,138
                      9,219
                      4,837

                      42.0
                      Insurance claims and indemnities
                      93
                      91
                      91

                      99.0
                      Direct obligations
                      10,104
                      10,200
                      5,540

                      99.0
                      Reimbursable obligations
                      57
                      58
                      47

                      99.9
                      Total new obligations, unexpired accounts
                      10,161
                      10,258
                      5,587

          Employment Summary

                      Identification code 075–0350–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,692
                      1,873
                      1,362

                      1101
                      Direct military average strength employment
                      187
                      207
                      160

                      2001
                      Reimbursable civilian full-time equivalent employment
                      51
                      58
                      53

                      2101
                      Reimbursable military average strength employment
                      4
                      4
                      4

             Health Resources and Services

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0350–4–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0010
                      Primary Health Care (Mandatory)

                      3,595

                      0020
                      Health Workforce (Mandatory)

                      370

                      0030
                      Maternal and Child Health (Mandatory)

                      5

                      0300
                      Total direct programs

                      3,970

                      0900
                      Total new obligations, unexpired accounts

                      3,970

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      3,975

                      1220
                      Appropriations transferred to other acct [015–5606]

                      –5

                      1260
                      Appropriations, mandatory (total)

                      3,970

                      1900
                      Budget authority (total)

                      3,970

                      1930
                      Total budgetary resources available

                      3,970

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      3,970

                      3020
                      Outlays (gross)

                      –1,561

                      3050
                      Unpaid obligations, end of year

                      2,409

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      2,409

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      3,970

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1,561

                      4180
                      Budget authority, net (total)

                      3,970

                      4190
                      Outlays, net (total)

                      1,561

             Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
                activities include support for Health Centers, health workforce programs, and maternal and child health care services.

          Object Classification (in millions of dollars)

                      Identification code 075–0350–4–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      49

                      11.3
                      Other than full-time permanent

                      2

                      11.5
                      Other personnel compensation

                      1

                      11.7
                      Military personnel

                      4

                      11.9
                      Total personnel compensation

                      56

                      12.1
                      Civilian personnel benefits

                      15

                      12.2
                      Military personnel benefits

                      2

                      23.1
                      Rental payments to GSA

                      5

                      23.3
                      Communications, utilities, and miscellaneous charges

                      2

                      25.2
                      Other services from non-Federal sources

                      37

                      25.3
                      Other goods and services from Federal sources

                      125

                      31.0
                      Equipment

                      2

                      41.0
                      Grants, subsidies, and contributions

                      3,726

                      99.9
                      Total new obligations, unexpired accounts

                      3,970

          Employment Summary

                      Identification code 075–0350–4–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      425

                      1101
                      Direct military average strength employment

                      41

             Vaccine Injury Compensation

             Program and Financing (in millions of dollars)

                      Identification code 075–0320–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      27
                      29
                      29

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      29
                      29
                      29

                      1930
                      Total budgetary resources available
                      29
                      29
                      29

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      29
                      29
                      29

                      Budget authority and outlays, net:

                      Mandatory:

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4170
                      Outlays, net (mandatory)
                      –2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –2

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

             Covered Countermeasure Process Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Claims
                      3
                      1
                      1

                      0103
                      Admin Expense
                      1
                      2
                      2

                      0900
                      Total new obligations, unexpired accounts
                      4
                      3
                      3

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      2
                      3
                      3

                      1050
                      Unobligated balance (total)
                      4
                      3
                      3

                      1930
                      Total budgetary resources available
                      4
                      3
                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      2
                      2

                      3010
                      New obligations, unexpired accounts
                      4
                      3
                      3

                      3020
                      Outlays (gross)
                      –2
                      –3
                      –3

                      3050
                      Unpaid obligations, end of year
                      2
                      2
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      2
                      2

                      3200
                      Obligated balance, end of year
                      2
                      2
                      2

                      Budget authority and outlays, net:

                      Discretionary:

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances
                      2
                      3
                      3

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      2
                      3
                      3

             The Covered Countermeasure Process Fund is established pursuant to the PHS Act, as amended by Division C of Public Law 109–148,
                to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration
                to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section
                319F-3(b) of the 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. 108–20).

          Object Classification (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2016 actual
                      2017 est.
                      2018 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
                      1
                      1

                      99.0
                      Direct obligations
                      4
                      3
                      3

                      99.9
                      Total new obligations, unexpired accounts
                      4
                      3
                      3

          Employment Summary

                      Identification code 075–0343–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      5
                      5
                      5

                      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 075–0321–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0010
                      Maternal, Infant, and Early Childhood Home Visiting Programs
                      391
                      405

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      16
                      37
                      4

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      11

                      1050
                      Unobligated balance (total)
                      28
                      37
                      4

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      400
                      400

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      –28

                      1260
                      Appropriations, mandatory (total)
                      400
                      372

                      1930
                      Total budgetary resources available
                      428
                      409
                      4

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      37
                      4
                      4

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      750
                      739
                      750

                      3010
                      New obligations, unexpired accounts
                      391
                      405

                      3020
                      Outlays (gross)
                      –390
                      –394
                      –375

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –11

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      739
                      750
                      375

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      750
                      739
                      750

                      3200
                      Obligated balance, end of year
                      739
                      750
                      375

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      400
                      372

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      14
                      15

                      4101
                      Outlays from mandatory balances
                      376
                      379
                      375

                      4110
                      Outlays, gross (total)
                      390
                      394
                      375

                      4180
                      Budget authority, net (total)
                      400
                      372

                      4190
                      Outlays, net (total)
                      390
                      394
                      375

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      400
                      372

                      Outlays
                      390
                      394
                      375

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      400

                      Outlays

                      16

                      Total:

                      Budget Authority
                      400
                      372
                      400

                      Outlays
                      390
                      394
                      391

              The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
                activities are administered by HRSA.

          Object Classification (in millions of dollars)

                      Identification code 075–0321–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      4
                      5

                      11.7
                      Military personnel
                      1
                      1

                      11.9
                      Total personnel compensation
                      5
                      6

                      12.1
                      Civilian personnel benefits
                      1
                      1

                      25.1
                      Advisory and assistance services
                      25
                      25

                      41.0
                      Grants, subsidies, and contributions
                      360
                      373

                      99.9
                      Total new obligations, unexpired accounts
                      391
                      405

          Employment Summary

                      Identification code 075–0321–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      33
                      39

                      1101
                      Direct military average strength employment
                      5
                      5

             Maternal, Infant, and Early Childhood Home Visiting Programs

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0321–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0010
                      Maternal, Infant, and Early Childhood Home Visiting Programs

                      400

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      400

                      1930
                      Total budgetary resources available

                      400

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      400

                      3020
                      Outlays (gross)

                      –16

                      3050
                      Unpaid obligations, end of year

                      384

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      384

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      400

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      16

                      4180
                      Budget authority, net (total)

                      400

                      4190
                      Outlays, net (total)

                      16

             The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
                activities are administered by HRSA.

          Object Classification (in millions of dollars)

                      Identification code 075–0321–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      5

                      11.7
                      Military personnel

                      1

                      11.9
                      Total personnel compensation

                      6

                      12.1
                      Civilian personnel benefits

                      1

                      25.1
                      Advisory and assistance services

                      25

                      41.0
                      Grants, subsidies, and contributions

                      368

                      99.9
                      Total new obligations, unexpired accounts

                      400

          Employment Summary

                      Identification code 075–0321–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      39

                      1101
                      Direct military average strength employment

                      5

             Health Center Guaranteed Loan Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0711
                      Default claim payments on principal

                      1

                      0742
                      Downward reestimates paid to receipt accounts

                      1

                      0900
                      Total new obligations, unexpired accounts

                      2

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      2

                      1930
                      Total budgetary resources available
                      2
                      2

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      2

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      2

                      3010
                      New obligations, unexpired accounts

                      2

                      3050
                      Unpaid obligations, end of year

                      2
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      2

                      3200
                      Obligated balance, end of year

                      2
                      2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

          Status of Guaranteed Loans (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Position with respect to appropriations act limitation on commitments:

                      2121
                      Limitation available from carry-forward
                      15
                      6
                      3

                      2143
                      Uncommitted limitation carried forward
                      –6
                      –3

                      2150
                      Total guaranteed loan commitments
                      9
                      3
                      3

                      2199
                      Guaranteed amount of guaranteed loan commitments
                      4
                      2
                      2

                      Cumulative balance of guaranteed loans outstanding:

                      2210
                      Outstanding, start of year
                      76
                      74
                      66

                      2231
                      Disbursements of new guaranteed loans
                      9
                      3
                      3

                      2251
                      Repayments and prepayments
                      –30
                      –10
                      –10

                      Adjustments:

                      2263
                      Terminations for default that result in claim payments

                      –1
                      –1

                      2264
                      Other adjustments, net
                      19

                      2290
                      Outstanding, end of year
                      74
                      66
                      58

                      Memorandum:

                      2299
                      Guaranteed amount of guaranteed loans outstanding, end of year
                      57
                      50
                      44

             Public Law 104–299 and Public Law 104–208 authorize Health Resources and Services Administration (HRSA) to guarantee up to
                $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and
                for the construction, renovation, and modernization of medical facilities. The program account for this activity is displayed
                in the Health Resources and Services account (75–0350) as a line in the program and financing schedule.

          Balance Sheet (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2015 actual
                      2016 actual

                      ASSETS:

                      1101
                      Federal assets: Fund balances with Treasury
                      3
                      2

                      1999
                      Total assets
                      3
                      2

                      LIABILITIES:

                      2204
                      Non-Federal liabilities: Liabilities for loan guarantees
                      3
                      2

                      4999
                      Total liabilities and net position
                      3
                      2

             Medical Facilities Guarantee and Loan Fund

             Status of Direct Loans (in millions of dollars)

                      Identification code 075–9931–0–3–551
                      2016 actual
                      2017 est.
                      2018 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 075–9931–0–3–551
                      2015 actual
                      2016 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 $9,200,000 shall be available from the Trust Fund to the Secretary.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      3,452
                      3,571
                      3,691

                      0198
                      Rounding adjustment
                      1

                      0199
                      Balance, start of year
                      3,453
                      3,571
                      3,691

                      Receipts:

                      Current law:

                      1110
                      Deposits, Vaccine Injury Compensation Trust Fund
                      291
                      293
                      300

                      1140
                      Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                      99
                      110
                      135

                      1199
                      Total current law receipts
                      390
                      403
                      435

                      1999
                      Total receipts
                      390
                      403
                      435

                      2000
                      Total: Balances and receipts
                      3,843
                      3,974
                      4,126

                      Appropriations:

                      Current law:

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –22
                      –23
                      –27

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –253
                      –260
                      –268

                      2199
                      Total current law appropriations
                      –275
                      –283
                      –295

                      2999
                      Total appropriations
                      –275
                      –283
                      –295

                      Special and trust fund receipts returned:

                      3010
                      Vaccine Injury Compensation Program Trust Fund
                      1

                      5098
                      Rounding adjustment
                      2

                      5099
                      Balance, end of year
                      3,571
                      3,691
                      3,831

          Program and Financing (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Compensation: Claims for post - FY 1989 injuries
                      253
                      260
                      268

                      0103
                      Claims processing (Claims Court)
                      5
                      6
                      9

                      0104
                      Claims processing (HRSA)
                      8
                      8
                      9

                      0105
                      Claims processing (Dept. of Justice)
                      9
                      9
                      9

                      0191
                      Direct program activities, subtotal
                      22
                      23
                      27

                      0900
                      Total new obligations, unexpired accounts
                      275
                      283
                      295

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1
                      1

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1

                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1030
                      Other balances withdrawn to special or trust funds
                      –1

                      1033
                      Recoveries of prior year paid obligations
                      3

                      1035
                      Unobligated balance of appropriations withdrawn
                      –3

                      1050
                      Unobligated balance (total)
                      1
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      22
                      23
                      27

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      253
                      260
                      268

                      1900
                      Budget authority (total)
                      275
                      283
                      295

                      1930
                      Total budgetary resources available
                      276
                      284
                      296

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1
                      1
                      1

                      Special and non-revolving trust funds:

                      1950
                      Other balances withdrawn and returned to unappropriated receipts
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      15
                      12

                      3010
                      New obligations, unexpired accounts
                      275
                      283
                      295

                      3020
                      Outlays (gross)
                      –276
                      –295
                      –295

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3050
                      Unpaid obligations, end of year
                      12

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      15
                      12

                      3200
                      Obligated balance, end of year
                      12

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      22
                      23
                      27

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      18
                      23
                      27

                      4011
                      Outlays from discretionary balances
                      5
                      12

                      4020
                      Outlays, gross (total)
                      23
                      35
                      27

                      Mandatory:

                      4090
                      Budget authority, gross
                      253
                      260
                      268

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      253
                      260
                      268

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –3

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      3

                      4160
                      Budget authority, net (mandatory)
                      253
                      260
                      268

                      4170
                      Outlays, net (mandatory)
                      250
                      260
                      268

                      4180
                      Budget authority, net (total)
                      275
                      283
                      295

                      4190
                      Outlays, net (total)
                      273
                      295
                      295

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      3,453
                      3,605
                      3,718

                      5001
                      Total investments, EOY: Federal securities: Par value
                      3,605
                      3,718
                      3,854

             The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203 and serves as
                a source of funds to pay claims for compensation for vaccine-related injury or death. 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 075–8175–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      2
                      2
                      2

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      25.3
                      Other goods and services from Federal sources
                      4
                      4
                      4

                      42.0
                      Insurance claims and indemnities
                      268
                      276
                      288

                      99.9
                      Total new obligations, unexpired accounts
                      275
                      283
                      295

          Employment Summary

                      Identification code 075–8175–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      14
                      13
                      16

                      1101
                      Direct military average strength employment
                      4
                      6
                      6

             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, $3,574,365,000, 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 for Purchased/Referred Care, including $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available
                until expended: Provided further, That, of the funds provided, up to $36,000,000 shall remain available until expended for implementation of the loan repayment
                program under section 108 of the Indian Health Care Improvement Act: Provided further, That, of the funds provided, $2,000,000 shall 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 Substance Abuse and Suicide Prevention Program, for the Domestic Violence Prevention Program, 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 93–638, such individually identifiable health information relating to disabled children
                as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
                U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
                Indian Health Facilities account.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Clinical services
                      3,237
                      3,231
                      3,252

                      0002
                      Preventive health
                      156
                      155
                      157

                      0003
                      Urban health
                      45
                      45
                      45

                      0004
                      Indian health professions
                      48
                      48
                      43

                      0005
                      Tribal management
                      2
                      2

                      0006
                      Direct operations
                      72
                      72
                      72

                      0007
                      Self-governance
                      6
                      6
                      5

                      0009
                      Diabetes funds
                      150
                      150

                      0799
                      Total direct obligations
                      3,716
                      3,709
                      3,574

                      0801
                      Indian Health Services (Reimbursable)
                      1,491
                      1,194
                      1,194

                      0900
                      Total new obligations, unexpired accounts
                      5,207
                      4,903
                      4,768

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      741
                      828
                      1,053

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      741
                      828

                      1021
                      Recoveries of prior year unpaid obligations
                      131

                      1050
                      Unobligated balance (total)
                      872
                      828
                      1,053

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,566
                      3,559
                      3,574

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      150
                      150

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      –3

                      1260
                      Appropriations, mandatory (total)
                      150
                      147

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,426
                      1,422
                      1,450

                      1701
                      Change in uncollected payments, Federal sources
                      30

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,456
                      1,422
                      1,450

                      1900
                      Budget authority (total)
                      5,172
                      5,128
                      5,024

                      1930
                      Total budgetary resources available
                      6,044
                      5,956
                      6,077

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –9

                      1941
                      Unexpired unobligated balance, end of year
                      828
                      1,053
                      1,309

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      917
                      984
                      542

                      3010
                      New obligations, unexpired accounts
                      5,207
                      4,903
                      4,768

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      44

                      3020
                      Outlays (gross)
                      –5,031
                      –5,345
                      –5,028

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –131

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –22

                      3050
                      Unpaid obligations, end of year
                      984
                      542
                      282

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –67
                      –98
                      –98

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –30

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      –1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –98
                      –98
                      –98

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      850
                      886
                      444

                      3200
                      Obligated balance, end of year
                      886
                      444
                      184

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,022
                      4,981
                      5,024

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,038
                      4,340
                      4,381

                      4011
                      Outlays from discretionary balances
                      827
                      858
                      641

                      4020
                      Outlays, gross (total)
                      4,865
                      5,198
                      5,022

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –231
                      –271
                      –276

                      4033
                      Non-Federal sources
                      –1,196
                      –1,151
                      –1,174

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,427
                      –1,422
                      –1,450

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –30

                      4052
                      Offsetting collections credited to expired accounts
                      1

                      4060
                      Additional offsets against budget authority only (total)
                      –29

                      4070
                      Budget authority, net (discretionary)
                      3,566
                      3,559
                      3,574

                      4080
                      Outlays, net (discretionary)
                      3,438
                      3,776
                      3,572

                      Mandatory:

                      4090
                      Budget authority, gross
                      150
                      147

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      58
                      141

                      4101
                      Outlays from mandatory balances
                      108
                      6
                      6

                      4110
                      Outlays, gross (total)
                      166
                      147
                      6

                      4180
                      Budget authority, net (total)
                      3,716
                      3,706
                      3,574

                      4190
                      Outlays, net (total)
                      3,604
                      3,923
                      3,578

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      3,716
                      3,706
                      3,574

                      Outlays
                      3,604
                      3,923
                      3,578

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      150

                      Outlays

                      144

                      Total:

                      Budget Authority
                      3,716
                      3,706
                      3,724

                      Outlays
                      3,604
                      3,923
                      3,722

             The Indian Health Services account provides medical care, public health services, and health professions training opportunities
                to American Indians and Alaska Natives. More than $2.2 billion, primarily through self-determination contracts and compacts,
                will be administered by tribal governments in 2018.

          Object Classification (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      393
                      398
                      406

                      11.3
                      Other than full-time permanent
                      18
                      18
                      18

                      11.5
                      Other personnel compensation
                      58
                      59
                      60

                      11.7
                      Military personnel
                      66
                      67
                      68

                      11.9
                      Total personnel compensation
                      535
                      542
                      552

                      12.1
                      Civilian personnel benefits
                      156
                      158
                      161

                      12.2
                      Military personnel benefits
                      29
                      30
                      30

                      13.0
                      Benefits for former personnel
                      2
                      1
                      2

                      21.0
                      Patient travel
                      46
                      46
                      43

                      22.0
                      Transportation of things
                      6
                      6
                      6

                      23.1
                      Rental payments to GSA
                      16
                      16
                      15

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      14
                      14
                      13

                      25.1
                      Advisory and assistance services
                      5
                      5
                      5

                      25.2
                      Other services from non-Federal sources
                      106
                      106
                      101

                      25.3
                      Other goods and services from Federal sources
                      72
                      71
                      66

                      25.4
                      Operation and maintenance of facilities
                      2
                      2
                      2

                      25.6
                      Medical care
                      392
                      391
                      371

                      25.7
                      Operation and maintenance of equipment
                      12
                      12
                      10

                      25.8
                      Subsistence and support of persons
                      4
                      4
                      4

                      26.0
                      Supplies and materials
                      98
                      98
                      93

                      31.0
                      Equipment
                      13
                      13
                      12

                      41.0
                      Grants, subsidies, and contributions
                      2,207
                      2,193
                      2,087

                      99.0
                      Direct obligations
                      3,716
                      3,709
                      3,574

                      99.0
                      Reimbursable obligations
                      1,491
                      1,194
                      1,194

                      99.9
                      Total new obligations, unexpired accounts
                      5,207
                      4,903
                      4,768

          Employment Summary

                      Identification code 075–0390–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      6,563
                      6,595
                      6,595

                      1101
                      Direct military average strength employment
                      963
                      968
                      968

                      2001
                      Reimbursable civilian full-time equivalent employment
                      5,460
                      5,460
                      5,460

                      2101
                      Reimbursable military average strength employment
                      802
                      802
                      802

             Indian Health Services

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0390–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0009
                      Diabetes funds

                      150

                      0799
                      Total direct obligations

                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      150

                      1930
                      Total budgetary resources available

                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      150

                      3020
                      Outlays (gross)

                      –144

                      3050
                      Unpaid obligations, end of year

                      6

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      6

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      144

                      4180
                      Budget authority, net (total)

                      150

                      4190
                      Outlays, net (total)

                      144

             This activity supports evidence-based diabetes treatment and prevention services across Indian Country.

          Object Classification (in millions of dollars)

                      Identification code 075–0390–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      21.0
                      Patient travel

                      2

                      23.1
                      Rental payments to GSA

                      1

                      25.2
                      Other services from non-Federal sources

                      5

                      25.3
                      Other goods and services from Federal sources

                      3

                      25.6
                      Medical care

                      20

                      25.7
                      Operation and maintenance of equipment

                      1

                      26.0
                      Supplies and materials

                      5

                      31.0
                      Equipment

                      1

                      41.0
                      Grants, subsidies, and contributions

                      112

                      99.0
                      Direct obligations

                      150

                      99.9
                      Total new obligations, unexpired accounts

                      150

             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 2018, 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0344–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Contract Support Costs
                      670
                      716
                      718

                      0900
                      Total new obligations (object class 25.3)
                      670
                      716
                      718

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      670
                      716
                      718

                      1930
                      Total budgetary resources available
                      670
                      716
                      718

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      40

                      3010
                      New obligations, unexpired accounts
                      670
                      716
                      718

                      3020
                      Outlays (gross)
                      –630
                      –756
                      –718

                      3050
                      Unpaid obligations, end of year
                      40

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      40

                      3200
                      Obligated balance, end of year
                      40

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      670
                      716
                      718

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      630
                      716
                      718

                      4011
                      Outlays from discretionary balances

                      40

                      4020
                      Outlays, gross (total)
                      630
                      756
                      718

                      4180
                      Budget authority, net (total)
                      670
                      716
                      718

                      4190
                      Outlays, net (total)
                      630
                      756
                      718

             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 $718 million in contract support
                costs funds will be provided to tribal governments and tribal organizations in 2018.

             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, $446,956,000, 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Rent and Charges for Quarters, Indian Health Service
                      7
                      9
                      9

                      2000
                      Total: Balances and receipts
                      7
                      9
                      9

                      Appropriations:

                      Current law:

                      2101
                      Indian Health Facilities
                      –7
                      –9
                      –9

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Maintenance
                      198
                      204
                      175

                      0002
                      Maintenance
                      74
                      73
                      60

                      0003
                      Facilities and environmental health
                      223
                      222
                      192

                      0004
                      Equipment
                      23
                      23
                      20

                      0100
                      Total direct program
                      518
                      522
                      447

                      0799
                      Total direct obligations
                      518
                      522
                      447

                      0801
                      Indian Health Facilities (Reimbursable)
                      9
                      9
                      9

                      0900
                      Total new obligations, unexpired accounts
                      527
                      531
                      456

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      236
                      284
                      340

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      236
                      284

                      1021
                      Recoveries of prior year unpaid obligations
                      11

                      1050
                      Unobligated balance (total)
                      247
                      284
                      340

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      523
                      522
                      447

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      7
                      9
                      9

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      31
                      56
                      57

                      1701
                      Change in uncollected payments, Federal sources
                      3

                      1750
                      Spending auth from offsetting collections, disc (total)
                      34
                      56
                      57

                      1900
                      Budget authority (total)
                      564
                      587
                      513

                      1930
                      Total budgetary resources available
                      811
                      871
                      853

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      284
                      340
                      397

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      455
                      492
                      455

                      3010
                      New obligations, unexpired accounts
                      527
                      531
                      456

                      3020
                      Outlays (gross)
                      –479
                      –568
                      –556

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –11

                      3050
                      Unpaid obligations, end of year
                      492
                      455
                      355

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5
                      –8
                      –8

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –3

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –8
                      –8
                      –8

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      450
                      484
                      447

                      3200
                      Obligated balance, end of year
                      484
                      447
                      347

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      557
                      578
                      504

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      293
                      213
                      191

                      4011
                      Outlays from discretionary balances
                      181
                      346
                      356

                      4020
                      Outlays, gross (total)
                      474
                      559
                      547

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –31
                      –56
                      –57

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –31
                      –56
                      –57

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –3

                      4070
                      Budget authority, net (discretionary)
                      523
                      522
                      447

                      4080
                      Outlays, net (discretionary)
                      443
                      503
                      490

                      Mandatory:

                      4090
                      Budget authority, gross
                      7
                      9
                      9

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3
                      9
                      9

                      4101
                      Outlays from mandatory balances
                      2

                      4110
                      Outlays, gross (total)
                      5
                      9
                      9

                      4180
                      Budget authority, net (total)
                      530
                      531
                      456

                      4190
                      Outlays, net (total)
                      448
                      512
                      499

             The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
                facilities support for the Indian Health Service. More than $186 million, primarily through self-determination contracts and
                compacts, will be administered by tribal governments in 2018.

          Object Classification (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      52
                      53
                      54

                      11.3
                      Other than full-time permanent
                      2
                      2
                      2

                      11.5
                      Other personnel compensation
                      2
                      2
                      3

                      11.7
                      Military personnel
                      22
                      22
                      23

                      11.9
                      Total personnel compensation
                      78
                      79
                      82

                      12.1
                      Civilian personnel benefits
                      18
                      18
                      19

                      12.2
                      Military personnel benefits
                      8
                      8
                      8

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      22.0
                      Transportation of things
                      3
                      3
                      3

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      15
                      15
                      15

                      25.1
                      Advisory and assistance services
                      3
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      76
                      76
                      76

                      25.3
                      Other goods and services from Federal sources
                      2
                      2
                      2

                      25.4
                      Operation and maintenance of facilities
                      6
                      6
                      6

                      25.7
                      Operation and maintenance of equipment
                      2
                      2
                      2

                      25.8
                      Subsistence and support of persons
                      13
                      13
                      13

                      26.0
                      Supplies and materials
                      7
                      7
                      7

                      31.0
                      Equipment
                      13
                      13
                      13

                      32.0
                      Land and structures
                      107
                      107
                      102

                      41.0
                      Grants, subsidies, and contributions
                      163
                      166
                      92

                      99.0
                      Direct obligations
                      518
                      522
                      447

                      99.0
                      Reimbursable obligations
                      9
                      9
                      9

                      99.9
                      Total new obligations, unexpired accounts
                      527
                      531
                      456

          Employment Summary

                      Identification code 075–0391–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,071
                      1,076
                      1,076

                      1101
                      Direct military average strength employment
                      163
                      158
                      158

                      2001
                      Reimbursable civilian full-time equivalent employment
                      37
                      37
                      37

             ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

             Administrative provisions—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. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
                Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
                care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
                recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility
                providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
                to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public
                Law 93–638: 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
                the House and Senate Committees on Appropriations are notified 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, notwithstanding any other provision of law, for any lease under section 105(l) of the Indian Self-Determination
                   and Education Assistance Act, as amended, no additional compensation is required by the Act above the amount provided to the
                   tribe or tribal organization under section 106(a)(1), except the Secretary, in the discretion of the Secretary, may award
                   compensation for such leases, above the section 106(a)(1) amount, and if the Secretary awards such additional compensation
                   the amount of such compensation may be based on such reasonable expenses, if any, as the Secretary determines to be appropriate,
                   which may include the expenses described in section 105(l)(2), and the exercise of this discretion to award additional compensation
                   and determine its amount is not subject to sections 102(a)-(b), (e) or 507(b)-(d) of the Act.

             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, $497,228,000.

             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, $934,000,000.

             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, $377,000,000: 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, $452,250,000: Provided, That amounts in this account, including amounts transferred to this account, are available for the Director of the
                   Centers for Disease Control and Prevention (CDC) to administer a program, to be known as America's Health State Block Grant,
                   to provide increased flexibility for States, territories, tribes, and tribal organizations to improve public health: Provided
                   further, That for purposes of carrying out such program, the Director is hereby authorized to award grants to States, territories,
                   tribes, and tribal organizations, and such grant awards shall be provided through a formula, as determined by the Director,
                   that takes into account the population and disease burden of the grantee: Provided further, That the Director may set aside
                   not more than 15 percent of the amounts awarded for grants described in the previous proviso for the same purposes, on a competitive
                   basis, to cities, Federally-recognized tribes, and public health entities serving rural and frontier areas or other entities:
                   Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for not
                less than 21 States, tribes, or tribal organizations: 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, $100,000,000.

             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, $317,032,000: Provided, That in addition to amounts provided herein, $142,968,000 shall be available from amounts available under section
                   241 of the PHS Act to carry out the Public Health Scientific Services.

             Environmental healthFor carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $157,000,000.

             Injury prevention and controlFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $216,165,000.

             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, $200,000,000.

             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 106–554.

             Global healthFor carrying out titles II, III, and XVII of the PHS Act with respect to global health, $350,000,000, of which $69,547,000 for international HIV/AIDS shall remain available through September 30, 2019: 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, $1,266,000,000, of which $575,000,000 shall remain available until expended for the Strategic National Stockpile: Provided, That the Director of the CDC or the Administrator of the Agency for Toxic Substances and Disease Registry may detail staff without reimbursement for up to 180 days to support an activation of the CDC Emergency Operations Center: Provided further, That in making awards under section 319C-1 of the PHS Act from funds made available under this heading,
                   the Secretary may determine the amounts of such awards without regard to paragraph (3)(B)-(D) and paragraph (4)(C) of subsection
                   (h) of such section.

             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, $105,000,000: 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, 2019: 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, Centers for Disease Control
                      1
                      2
                      2

                      2000
                      Total: Balances and receipts
                      1
                      2
                      2

                      Appropriations:

                      Current law:

                      2101
                      CDC-wide Activities and Program Support
                      –1
                      –2
                      –2

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Birth Defects, Developmental Disabilities, Disability and Health (0958)
                      135
                      135
                      100

                      0002
                      CDC-Wide Activities and Program Support (0943)
                      464
                      273
                      105

                      0004
                      Chronic Disease Prevention and Health Promotion (0948)
                      1,173
                      1,175
                      952

                      0005
                      Emerging and Zoonotic Infectious Diseases (0949)
                      583
                      579
                      514

                      0006
                      Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                      49
                      50
                      55

                      0007
                      Environmental Health (0947)
                      182
                      217
                      157

                      0008
                      Global Health (0955)
                      426
                      426
                      350

                      0012
                      HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                      1,121
                      1,120
                      934

                      0013
                      Immunization and Respiratory Diseases (0951)
                      797
                      783
                      701

                      0015
                      Injury Prevention and Control (0952)
                      236
                      236
                      216

                      0016
                      Occupational Safety and Health (0953)
                      338
                      338
                      200

                      0019
                      Public Health Preparedness and Response (0956)
                      1,370
                      1,402
                      1,266

                      0020
                      Public Health Scientific Services (0959)
                      490
                      491
                      317

                      0021
                      Cooperative Research and Development Agreements (CRADA) (5146)
                      1
                      2
                      2

                      0022
                      Ebola (Emergency pursuant to 2011 BCA)
                      380

                      0799
                      Total direct obligations
                      7,745
                      7,227
                      5,869

                      0802
                      CDC-Wide Activities and Program Support (Reimbursable)
                      322
                      412
                      411

                      0809
                      Reimbursable program activities, subtotal
                      322
                      412
                      411

                      0900
                      Total new obligations, unexpired accounts
                      8,067
                      7,639
                      6,280

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,223
                      1,155
                      1,155

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1,107
                      1,110

                      1010
                      Unobligated balance transfer to other accts [075–9915]
                      –3

                      1010
                      Unobligated balance transfer to other accts [075–0140]
                      –14

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      15

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      10

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      20

                      1021
                      Recoveries of prior year unpaid obligations
                      40

                      1050
                      Unobligated balance (total)
                      1,291
                      1,155
                      1,155

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      6,655
                      6,284
                      4,972

                      1121
                      Appropriations transferred from other acct [075–9912]
                      1

                      1121
                      Appropriations transferred from other acct [075–1362]
                      4

                      1160
                      Appropriation, discretionary (total)
                      6,660
                      6,284
                      4,972

                      Appropriations, mandatory:

                      1200
                      Appropriation (075–0954 - EEOICPA)
                      55
                      55
                      55

                      1200
                      Appropriation (075–0943 - Chilhood Obesity Demonstration Project)
                      10

                      1201
                      Appropriation (075–5146 CRADA)
                      1
                      2
                      2

                      1221
                      Appropriations transferred from other acct [075–0116]
                      892
                      891
                      841

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –5
                      –5

                      1260
                      Appropriations, mandatory (total)
                      953
                      943
                      898

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      138
                      408
                      408

                      1700
                      Collected
                      4

                      1701
                      Change in uncollected payments, Federal sources
                      177

                      1750
                      Spending auth from offsetting collections, disc (total)
                      319
                      408
                      408

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      4
                      4
                      4

                      1900
                      Budget authority (total)
                      7,936
                      7,639
                      6,282

                      1930
                      Total budgetary resources available
                      9,227
                      8,794
                      7,437

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –5

                      1941
                      Unexpired unobligated balance, end of year
                      1,155
                      1,155
                      1,157

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      6,500
                      6,949
                      6,639

                      3010
                      New obligations, unexpired accounts
                      8,067
                      7,639
                      6,280

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      51

                      3020
                      Outlays (gross)
                      –7,426
                      –7,949
                      –7,253

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –40

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –203

                      3050
                      Unpaid obligations, end of year
                      6,949
                      6,639
                      5,666

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –132
                      –232
                      –232

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –177

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      77

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –232
                      –232
                      –232

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      6,368
                      6,717
                      6,407

                      3200
                      Obligated balance, end of year
                      6,717
                      6,407
                      5,434

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      6,979
                      6,692
                      5,380

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,663
                      2,916
                      2,381

                      4011
                      Outlays from discretionary balances
                      3,842
                      4,317
                      3,911

                      4020
                      Outlays, gross (total)
                      6,505
                      7,233
                      6,292

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –199
                      –408
                      –408

                      4033
                      Non-Federal sources
                      –7

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –206
                      –408
                      –408

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –177

                      4052
                      Offsetting collections credited to expired accounts
                      64

                      4060
                      Additional offsets against budget authority only (total)
                      –113

                      4070
                      Budget authority, net (discretionary)
                      6,660
                      6,284
                      4,972

                      4080
                      Outlays, net (discretionary)
                      6,299
                      6,825
                      5,884

                      Mandatory:

                      4090
                      Budget authority, gross
                      957
                      947
                      902

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      177
                      158
                      155

                      4101
                      Outlays from mandatory balances
                      744
                      558
                      806

                      4110
                      Outlays, gross (total)
                      921
                      716
                      961

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –4
                      –4
                      –4

                      4180
                      Budget authority, net (total)
                      7,613
                      7,227
                      5,870

                      4190
                      Outlays, net (total)
                      7,216
                      7,537
                      6,841

             The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health,
                safety, and protection of all Americans. These activities include immunization and respiratory diseases, HIV/AIDS, Hepatitis,
                STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion,
                occupational safety and health, public health and scientific services, injury prevention and control, environmental health,
                global health, programs that reduce the occurrence of birth defects and developmental disabilities, public health preparedness
                and emergency response, and CDC-wide activities and program support. The FY 2018 Budget reforms CDC's funding by establishing
                a new $500 million block grant to increase flexibility for States to address their population's unique public health needs.

          Object Classification (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      714
                      802
                      800

                      11.3
                      Other than full-time permanent
                      124
                      107
                      107

                      11.5
                      Other personnel compensation
                      39
                      35
                      35

                      11.7
                      Military personnel
                      77
                      75
                      75

                      11.8
                      Special personal services payments
                      9
                      8
                      8

                      11.9
                      Total personnel compensation
                      963
                      1,027
                      1,025

                      12.1
                      Civilian personnel benefits
                      287
                      308
                      308

                      12.2
                      Military personnel benefits
                      54
                      50
                      49

                      13.0
                      Benefits for former personnel
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      78
                      46
                      34

                      22.0
                      Transportation of things
                      16
                      13
                      10

                      23.1
                      Rental payments to GSA
                      8
                      28
                      21

                      23.2
                      Rental payments to others
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      17
                      36
                      27

                      24.0
                      Printing and reproduction
                      3
                      3
                      2

                      25.1
                      Advisory and assistance services
                      922
                      866
                      684

                      25.2
                      Other services from non-Federal sources
                      197
                      251
                      188

                      25.3
                      Other goods and services from Federal sources
                      780
                      351
                      268

                      25.4
                      Operation and maintenance of facilities
                      19
                      57
                      40

                      25.5
                      Research and development contracts
                      35
                      35
                      26

                      25.6
                      Medical care
                      31
                      28
                      21

                      25.7
                      Operation and maintenance of equipment
                      52
                      90
                      66

                      25.8
                      Subsistence and support of persons
                      2
                      2
                      2

                      26.0
                      Supplies and materials
                      456
                      438
                      333

                      31.0
                      Equipment
                      59
                      69
                      51

                      32.0
                      Land and structures
                      6
                      10
                      1

                      41.0
                      Grants, subsidies, and contributions
                      3,758
                      3,518
                      2,711

                      99.0
                      Direct obligations
                      7,745
                      7,227
                      5,868

                      99.0
                      Reimbursable obligations
                      322
                      412
                      412

                      99.9
                      Total new obligations, unexpired accounts
                      8,067
                      7,639
                      6,280

          Employment Summary

                      Identification code 075–0943–0–1–999
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      9,096
                      9,287
                      9,287

                      1101
                      Direct military average strength employment
                      876
                      877
                      877

                      2001
                      Reimbursable civilian full-time equivalent employment
                      218
                      184
                      184

                      2101
                      Reimbursable military average strength employment
                      37
                      30
                      30

             buildings and facilities
             For equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2022.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      CDC Buildings and Facilities (0960)
                      9
                      10
                      20

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      3
                      3

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      10
                      10
                      20

                      1930
                      Total budgetary resources available
                      12
                      13
                      23

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3
                      3
                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      6
                      6
                      7

                      3010
                      New obligations, unexpired accounts
                      9
                      10
                      20

                      3020
                      Outlays (gross)
                      –9
                      –9
                      –14

                      3050
                      Unpaid obligations, end of year
                      6
                      7
                      13

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      6
                      6
                      7

                      3200
                      Obligated balance, end of year
                      6
                      7
                      13

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      10
                      10
                      20

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2
                      4
                      8

                      4011
                      Outlays from discretionary balances
                      7
                      5
                      6

                      4020
                      Outlays, gross (total)
                      9
                      9
                      14

                      4180
                      Budget authority, net (total)
                      10
                      10
                      20

                      4190
                      Outlays, net (total)
                      9
                      9
                      14

          Object Classification (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      2
                      2
                      3

                      25.4
                      Operation and maintenance of facilities
                      4
                      4
                      4

                      25.7
                      Operation and maintenance of equipment

                      1
                      2

                      32.0
                      Land and structures
                      3
                      3
                      11

                      99.9
                      Total new obligations, unexpired accounts
                      9
                      10
                      20

             CDC Working Capital Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–4553–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      CDC Working Capital Fund (Reimbursable)
                      590
                      532
                      532

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      52
                      52
                      52

                      1021
                      Recoveries of prior year unpaid obligations
                      19

                      1050
                      Unobligated balance (total)
                      71
                      52
                      52

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      569
                      532
                      532

                      1701
                      Change in uncollected payments, Federal sources
                      2

                      1750
                      Spending auth from offsetting collections, disc (total)
                      571
                      532
                      532

                      1930
                      Total budgetary resources available
                      642
                      584
                      584

                      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
                      175
                      217
                      204

                      3010
                      New obligations, unexpired accounts
                      590
                      532
                      532

                      3020
                      Outlays (gross)
                      –529
                      –545
                      –534

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –19

                      3050
                      Unpaid obligations, end of year
                      217
                      204
                      202

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1

                      –2
                      –2

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –2

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –2
                      –2
                      –2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      175
                      215
                      202

                      3200
                      Obligated balance, end of year
                      215
                      202
                      200

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      571
                      532
                      532

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      377
                      351
                      351

                      4011
                      Outlays from discretionary balances
                      152
                      194
                      183

                      4020
                      Outlays, gross (total)
                      529
                      545
                      534

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –569
                      –532
                      –532

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –2

                      4080
                      Outlays, net (discretionary)
                      –40
                      13
                      2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –40
                      13
                      2

             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 075–4553–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      143
                      160
                      160

                      11.3
                      Other than full-time permanent
                      4
                      4
                      4

                      11.5
                      Other personnel compensation
                      3
                      3
                      3

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      153
                      170
                      170

                      12.1
                      Civilian personnel benefits
                      48
                      53
                      53

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      1
                      2
                      2

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      33
                      33
                      33

                      23.3
                      Communications, utilities, and miscellaneous charges
                      27
                      27
                      27

                      25.1
                      Advisory and assistance services
                      31
                      25
                      25

                      25.2
                      Other services from non-Federal sources
                      89
                      57
                      57

                      25.3
                      Other goods and services from Federal sources
                      66
                      63
                      63

                      25.4
                      Operation and maintenance of facilities
                      54
                      40
                      40

                      25.7
                      Operation and maintenance of equipment
                      55
                      40
                      40

                      26.0
                      Supplies and materials
                      1
                      3
                      3

                      31.0
                      Equipment
                      22
                      9
                      9

                      32.0
                      Land and structures
                      8
                      8
                      8

                      99.9
                      Total new obligations, unexpired accounts
                      590
                      532
                      532

          Employment Summary

                      Identification code 075–4553–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,265
                      1,256
                      1,256

                      2101
                      Reimbursable military average strength employment
                      22
                      22
                      22

             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, $62,000,000: 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 2018, and existing profiles may be updated as necessary.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Agency for Toxic Substances and Disease Registry, Toxic Substanc (Direct)
                      78
                      75
                      62

                      0801
                      Agency for Toxic Substances and Disease Registry, Toxic Substanc (Reimbursable)
                      5
                      6
                      6

                      0900
                      Total new obligations, unexpired accounts
                      83
                      81
                      68

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      27
                      25
                      25

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      28
                      25
                      25

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      75
                      75
                      62

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      2
                      6
                      3

                      1701
                      Change in uncollected payments, Federal sources
                      3

                      1750
                      Spending auth from offsetting collections, disc (total)
                      5
                      6
                      3

                      1900
                      Budget authority (total)
                      80
                      81
                      65

                      1930
                      Total budgetary resources available
                      108
                      106
                      90

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      25
                      25
                      22

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      44
                      47
                      28

                      3010
                      New obligations, unexpired accounts
                      83
                      81
                      68

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1

                      3020
                      Outlays (gross)
                      –79
                      –100
                      –76

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      47
                      28
                      20

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5
                      –5
                      –5

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –3

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      3

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –5
                      –5
                      –5

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      39
                      42
                      23

                      3200
                      Obligated balance, end of year
                      42
                      23
                      15

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      80
                      81
                      65

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      49
                      56
                      45

                      4011
                      Outlays from discretionary balances
                      27
                      44
                      31

                      4020
                      Outlays, gross (total)
                      76
                      100
                      76

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –5
                      –6
                      –3

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –3

                      4052
                      Offsetting collections credited to expired accounts
                      3

                      4070
                      Budget authority, net (discretionary)
                      75
                      75
                      62

                      4080
                      Outlays, net (discretionary)
                      71
                      94
                      73

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      3

                      4180
                      Budget authority, net (total)
                      75
                      75
                      62

                      4190
                      Outlays, net (total)
                      74
                      94
                      73

          Object Classification (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      22
                      20
                      20

                      11.3
                      Other than full-time permanent
                      2
                      2
                      2

                      11.7
                      Military personnel
                      4
                      4
                      4

                      11.9
                      Total personnel compensation
                      28
                      26
                      26

                      12.1
                      Civilian personnel benefits
                      7
                      7
                      7

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      11
                      11
                      7

                      25.2
                      Other services from non-Federal sources
                      4
                      4
                      3

                      25.3
                      Other goods and services from Federal sources
                      10
                      11
                      7

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      16
                      13
                      9

                      99.0
                      Direct obligations
                      79
                      75
                      62

                      99.0
                      Reimbursable obligations
                      4
                      6
                      6

                      99.9
                      Total new obligations, unexpired accounts
                      83
                      81
                      68

          Employment Summary

                      Identification code 075–0944–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      222
                      227
                      227

                      1101
                      Direct military average strength employment
                      38
                      33
                      33

                      2001
                      Reimbursable civilian full-time equivalent employment
                      9
                      9
                      9

             World Trade Center Health Program Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      World Trade Center Health Program - Federal Share (CDC/NIOSH)
                      313
                      347
                      366

                      0002
                      World Trade Center Health Program - NYC

                      39
                      41

                      0900
                      Total new obligations, unexpired accounts
                      313
                      386
                      407

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      797
                      967

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      98
                      160

                      1050
                      Unobligated balance (total)
                      98
                      957
                      967

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (WTC (CDC Direct))
                      990
                      346
                      380

                      1200
                      Appropriation (WTC—NYC DHSS—CDC)
                      33
                      38
                      42

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –23

                      1260
                      Appropriations, mandatory (total)
                      1,000
                      384
                      422

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      12
                      12

                      1900
                      Budget authority (total)
                      1,012
                      396
                      422

                      1930
                      Total budgetary resources available
                      1,110
                      1,353
                      1,389

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      797
                      967
                      982

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      161
                      168
                      275

                      3010
                      New obligations, unexpired accounts
                      313
                      386
                      407

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      31

                      3020
                      Outlays (gross)
                      –293
                      –279
                      –345

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –44

                      3050
                      Unpaid obligations, end of year
                      168
                      275
                      337

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      161
                      168
                      275

                      3200
                      Obligated balance, end of year
                      168
                      275
                      337

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,012
                      396
                      422

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      204
                      182
                      194

                      4101
                      Outlays from mandatory balances
                      89
                      97
                      151

                      4110
                      Outlays, gross (total)
                      293
                      279
                      345

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –48
                      –12

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      36

                      4160
                      Budget authority, net (mandatory)
                      1,000
                      384
                      422

                      4170
                      Outlays, net (mandatory)
                      245
                      267
                      345

                      4180
                      Budget authority, net (total)
                      1,000
                      384
                      422

                      4190
                      Outlays, net (total)
                      245
                      267
                      345

             HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347)
                on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the
                Program Administrator for the 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. 114–113, Division O, Title III). The amounts included for 2017 and 2018 in
                the Budget reflect estimated Federal obligations for the WTC Health Program.

          Object Classification (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2016 actual
                      2017 est.
                      2018 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
                      23
                      32
                      36

                      25.2
                      Other services from non-Federal sources
                      58
                      74
                      72

                      25.3
                      Other goods and services from Federal sources
                      11
                      13
                      13

                      25.6
                      Medical care
                      1

                      41.0
                      Grants, subsidies, and contributions
                      15
                      24
                      24

                      42.0
                      Insurance claims and indemnities
                      201
                      239
                      258

                      99.9
                      Total new obligations, unexpired accounts
                      313
                      386
                      407

          Employment Summary

                      Identification code 075–0946–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      16
                      16
                      16

                      1101
                      Direct military average strength employment
                      7
                      7
                      7

             National Institutes of Health

             Federal Funds
             national cancer instituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer, $4,174,222,000, of which up to $10,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research
                and Development Center in Frederick, Maryland.

             national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
                and blood products, $2,534,803,000.

             national institute of dental and craniofacial researchFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $320,749,000.

             national institute of diabetes and digestive and kidney diseasesFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,449,534,000.

             national institute of neurological disorders and strokeFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,312,998,000.

             national institute of allergy and infectious diseasesFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $3,782,670,000.

             national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $2,185,509,000, of which $780,000,000 shall be from funds available under section 241 of the PHS Act.

             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, $1,032,029,000.

             national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $549,847,000.

             national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $533,537,000.

             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, $59,607,000.

             national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging, $1,303,541,000.

             national institute of arthritis and musculoskeletal and skin diseasesFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
                $417,898,000.

             national institute on deafness and other communication disordersFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $325,846,000.

             national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, $113,688,000.

             national institute on alcohol abuse and alcoholismFor carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $361,356,000

             national institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $864,998,000.

             national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,201,901,000.

             national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, $399,622,000.

             national institute of biomedical imaging and bioengineeringFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $282,614,000.

             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, $101,793,000.

             national institute on minority health and health disparitiesFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
                $214,723,000.

             john e. fogarty international center

             national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, $373,258,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30,
                2019: Provided further, That in fiscal year 2018, 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").

             national center for advancing translational sciencesFor carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $557,373,000: Provided, That up to $24,496,593 shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.

             office of the directorFor carrying out the responsibilities of the Office of the Director, NIH, $1,329,833,000: 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 $441,823,000 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 $4,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act.
          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.

             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, $98,615,000, to remain available through September 30, 2022.
              National Institute for Research on Safety 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, $272,000,000: Provided, That section 947(c) of the
                   PHS Act shall not apply in fiscal year 2018: 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 expended.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      11

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, NIH
                      34
                      17
                      17

                      2000
                      Total: Balances and receipts
                      34
                      17
                      28

                      Appropriations:

                      Current law:

                      2101
                      National Institutes of Health
                      –34
                      –16
                      –16

                      2134
                      National Institutes of Health

                      10

                      2199
                      Total current law appropriations
                      –34
                      –6
                      –16

                      2999
                      Total appropriations
                      –34
                      –6
                      –16

                      5099
                      Balance, end of year

                      11
                      12

          Program and Financing (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      National Cancer Institute (0849)
                      5,356
                      5,505
                      4,474

                      0002
                      National Heart, Lung, and Blood Institute (0872)
                      3,109
                      3,110
                      2,535

                      0003
                      National Institute of Dental and Craniofacial Research (0873)
                      413
                      415
                      321

                      0004
                      National Institute of Diabetes and Digestive and Kidney Disease (0884)
                      1,814
                      1,815
                      1,450

                      0005
                      National Institute of Neurological Disorders and Stroke (0886)
                      1,693
                      1,693
                      1,356

                      0006
                      National Institute of Allergy and Infectious Diseases (0885)
                      4,827
                      4,621
                      3,783

                      0007
                      National Institute of General Medical Sciences (0851)
                      1,729
                      1,729
                      1,406

                      0008
                      National Institute of Child Health and Human Development (0844)
                      1,338
                      1,337
                      1,032

                      0009
                      National Eye Institute (0887)
                      707
                      715
                      550

                      0010
                      National Institute of Environmental Health Sciences (0862)
                      695
                      770
                      593

                      0011
                      National Institute on Aging (0843)
                      1,602
                      1,597
                      1,304

                      0012
                      National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                      541
                      541
                      418

                      0013
                      National Institute on Deafness and Other Communication Disorder (0890)
                      422
                      422
                      326

                      0014
                      National Institute of Mental Health (0892)
                      1,516
                      1,545
                      1,245

                      0015
                      National Institute on Drug Abuse (0893)
                      1,049
                      1,075
                      865

                      0016
                      National Institute on Alcohol Abuse and Alcoholism (0894)
                      467
                      467
                      361

                      0017
                      National Institute of Nursing Research (0889)
                      146
                      146
                      114

                      0018
                      National Human Genome Research Institute (0891)
                      512
                      518
                      400

                      0019
                      National Institute of Biomedical Imaging and Bioengineering (0898)
                      343
                      346
                      283

                      0021
                      National Center for Complementary and Integrative Health (0896)
                      130
                      131
                      102

                      0022
                      National Institute on Minority Health and Health Disparities (0897)
                      280
                      279
                      215

                      0023
                      John E. Fogarty International Center (0819)
                      70
                      70

                      0024
                      National Library of Medicine (0807)
                      395
                      394
                      373

                      0025
                      NIH Office of the Director (0846)
                      1,571
                      1,568
                      1,342

                      0026
                      NIH Buildings and facilities (0838)
                      80
                      129
                      99

                      0027
                      NIH Cooperative Research and Development Agreements
                      26
                      16
                      16

                      0028
                      National Center for Advancing Translational Sciences (0875)
                      684
                      684
                      557

                      0029
                      National Institute for Research on Safety and Quality

                      272

                      0031
                      Type 1 Diabetes
                      150
                      140

                      0799
                      Total direct obligations
                      31,665
                      31,778
                      25,792

                      0801
                      NIH Reimbursable - Other
                      3,598
                      3,767
                      3,609

                      0802
                      NIH Royalties
                      132
                      105
                      105

                      0809
                      Reimbursable program activities, subtotal
                      3,730
                      3,872
                      3,714

                      0899
                      Total reimbursable obligations
                      3,730
                      3,872
                      3,714

                      0900
                      Total new obligations, unexpired accounts
                      35,395
                      35,650
                      29,506

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      722
                      1,363
                      1,049

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      722
                      1,363

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      47

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      4

                      1011
                      Unobligated balance transfer from other acct [075–0943]
                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      131

                      1033
                      Recoveries of prior year paid obligations
                      35

                      1050
                      Unobligated balance (total)
                      942
                      1,363
                      1,049

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      31,521
                      31,308
                      25,374

                      1121
                      Appropriations transferred from other acct [075–5736]
                      13
                      13
                      13

                      1121
                      Appropriations transferred from other acct [075–5628]

                      300
                      386

                      1160
                      Appropriation, discretionary (total)
                      31,534
                      31,621
                      25,773

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      150
                      150

                      1201
                      Appropriation (special or trust fund)
                      34
                      16
                      16

                      1234
                      Appropriations precluded from obligation

                      –10

                      1260
                      Appropriations, mandatory (total)
                      184
                      156
                      16

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3,563
                      3,559
                      3,559

                      1701
                      Change in uncollected payments, Federal sources
                      540

                      1750
                      Spending auth from offsetting collections, disc (total)
                      4,103
                      3,559
                      3,559

                      1900
                      Budget authority (total)
                      35,821
                      35,336
                      29,348

                      1930
                      Total budgetary resources available
                      36,763
                      36,699
                      30,397

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –5

                      1941
                      Unexpired unobligated balance, end of year
                      1,363
                      1,049
                      891

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      31,352
                      32,959
                      32,945

                      3010
                      New obligations, unexpired accounts
                      35,395
                      35,650
                      29,506

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      883

                      3020
                      Outlays (gross)
                      –33,453
                      –35,664
                      –33,667

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –131

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1,087

                      3050
                      Unpaid obligations, end of year
                      32,959
                      32,945
                      28,784

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –979
                      –1,207
                      –1,207

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –540

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      312

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –1,207
                      –1,207
                      –1,207

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      30,373
                      31,752
                      31,738

                      3200
                      Obligated balance, end of year
                      31,752
                      31,738
                      27,577

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      35,637
                      35,180
                      29,332

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      9,817
                      12,096
                      11,933

                      4011
                      Outlays from discretionary balances
                      23,462
                      23,403
                      21,609

                      4020
                      Outlays, gross (total)
                      33,279
                      35,499
                      33,542

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –4,013
                      –3,559
                      –3,559

                      4033
                      Non-Federal sources
                      –157

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,170
                      –3,559
                      –3,559

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –540

                      4052
                      Offsetting collections credited to expired accounts
                      575

                      4053
                      Recoveries of prior year paid obligations, unexpired accounts
                      32

                      4060
                      Additional offsets against budget authority only (total)
                      67

                      4070
                      Budget authority, net (discretionary)
                      31,534
                      31,621
                      25,773

                      4080
                      Outlays, net (discretionary)
                      29,109
                      31,940
                      29,983

                      Mandatory:

                      4090
                      Budget authority, gross
                      184
                      156
                      16

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2
                      50
                      16

                      4101
                      Outlays from mandatory balances
                      172
                      115
                      109

                      4110
                      Outlays, gross (total)
                      174
                      165
                      125

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –3

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      3

                      4160
                      Budget authority, net (mandatory)
                      184
                      156
                      16

                      4170
                      Outlays, net (mandatory)
                      171
                      165
                      125

                      4180
                      Budget authority, net (total)
                      31,718
                      31,777
                      25,789

                      4190
                      Outlays, net (total)
                      29,280
                      32,105
                      30,108

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      31,718
                      31,777
                      25,789

                      Outlays
                      29,280
                      32,105
                      30,108

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      150

                      Outlays

                      36

                      Total:

                      Budget Authority
                      31,718
                      31,777
                      25,939

                      Outlays
                      29,280
                      32,105
                      30,144

             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. The FY 2018 Budget consolidates
                the Agency for Healthcare Research and Quality within the National Institutes of Health as the National Institute for Research
                on Safety and Quality, and dissolves the Fogarty International Center. Detailed information is available through the Department
                of Health and Human Services.

          Object Classification (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      941
                      971
                      1,021

                      11.3
                      Other than full-time permanent
                      505
                      514
                      527

                      11.5
                      Other personnel compensation
                      37
                      37
                      38

                      11.7
                      Military personnel
                      19
                      20
                      20

                      11.8
                      Special personal services payments
                      168
                      168
                      160

                      11.9
                      Total personnel compensation
                      1,670
                      1,710
                      1,766

                      12.1
                      Civilian personnel benefits
                      482
                      496
                      518

                      12.2
                      Military personnel benefits
                      12
                      12
                      14

                      21.0
                      Travel and transportation of persons
                      53
                      53
                      33

                      22.0
                      Transportation of things
                      5
                      5
                      3

                      23.1
                      Rental payments to GSA
                      22
                      23
                      18

                      23.3
                      Communications, utilities, and miscellaneous charges
                      26
                      26
                      18

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      171
                      166
                      120

                      25.2
                      Other services from non-Federal sources
                      1,244
                      1,130
                      790

                      25.3
                      Other goods and services from Federal sources
                      3,048
                      3,092
                      2,769

                      25.4
                      Operation and maintenance of facilities
                      168
                      215
                      167

                      25.5
                      Research and development contracts
                      1,515
                      1,457
                      1,250

                      25.6
                      Medical care
                      34
                      34
                      21

                      25.7
                      Operation and maintenance of equipment
                      116
                      117
                      80

                      26.0
                      Supplies and materials
                      209
                      212
                      114

                      31.0
                      Equipment
                      173
                      168
                      97

                      41.0
                      Grants, subsidies, and contributions
                      22,716
                      22,861
                      18,013

                      99.0
                      Direct obligations
                      31,665
                      31,778
                      25,792

                      99.0
                      Reimbursable obligations
                      3,730
                      3,872
                      3,714

                      99.9
                      Total new obligations, unexpired accounts
                      35,395
                      35,650
                      29,506

          Employment Summary

                      Identification code 075–9915–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      12,958
                      13,335
                      13,581

                      1101
                      Direct military average strength employment
                      175
                      165
                      165

                      2001
                      Reimbursable civilian full-time equivalent employment
                      4,490
                      4,515
                      4,516

                      2101
                      Reimbursable military average strength employment
                      100
                      90
                      90

             National Institutes of Health

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–9915–4–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0031
                      Type 1 Diabetes

                      150

                      0799
                      Total direct obligations

                      150

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      150

                      1900
                      Budget authority (total)

                      150

                      1930
                      Total budgetary resources available

                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      150

                      3020
                      Outlays (gross)

                      –36

                      3050
                      Unpaid obligations, end of year

                      114

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      114

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      36

                      4180
                      Budget authority, net (total)

                      150

                      4190
                      Outlays, net (total)

                      36

             Payment to the NIH Innovation Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0147–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Payment to NIH Innovation (object class 94.0)

                      352
                      496

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)

                      352
                      496

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      352
                      496

                      1930
                      Total budgetary resources available

                      352
                      496

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      352
                      496

                      3020
                      Outlays (gross)

                      –352
                      –496

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      352
                      496

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      352
                      496

                      4180
                      Budget authority, net (total)

                      352
                      496

                      4190
                      Outlays, net (total)

                      352
                      496

             This account, and a related special receipt account, were established to support the execution structure necessary to implement
                the 21st Century Cures Act.

             NIH Innovation, CURES Act For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition
                   to amounts available for such purposes in the appropriations provided to the National Institutes of Health in this Act, $496,000,000,
                   to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act
                   and are to be derived from amounts transferred under section 1001(b)(2)(A) of such Act: Provided further, That of the amount
                   appropriated under this heading, $300,000,000 shall be transferred to the "National Cancer Institute" for the purposes described
                   in section 1001(b)(4)(C) of such Act, $43,000,000 shall be transferred to the "National Institute of Neurological Disorders
                   and Stroke" for the purposes described in section 1001(b)(4)(B) of such Act, and $43,000,000 shall be transferred to the "National
                   Institute of Mental Health" for the purposes described in section 1001(b)(4)(B) of such Act: Provided further, That remaining
                   amounts may be transferred by the Director of the National Institutes of Health to any accounts of the National Institutes
                   of Health: Provided further, That upon a determination by the Director that funds transferred pursuant to any of the previous
                   provisos are not necessary for the purposes provided, such amounts may be transferred back to this account: Provided further,
                   That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, NIH Innovation, CURES Act

                      352
                      496

                      2000
                      Total: Balances and receipts

                      352
                      496

                      Appropriations:

                      Current law:

                      2101
                      NIH Innovation, Cures Act

                      –352
                      –496

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      CURES obligations

                      52
                      110

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      52
                      110

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)

                      352
                      496

                      1120
                      Appropriations transferred to other acct [075–9915]

                      –300
                      –386

                      1160
                      Appropriation, discretionary (total)

                      52
                      110

                      1930
                      Total budgetary resources available

                      52
                      110

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      40

                      3010
                      New obligations, unexpired accounts

                      52
                      110

                      3020
                      Outlays (gross)

                      –12
                      –51

                      3050
                      Unpaid obligations, end of year

                      40
                      99

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      40

                      3200
                      Obligated balance, end of year

                      40
                      99

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      52
                      110

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      12
                      26

                      4011
                      Outlays from discretionary balances

                      25

                      4020
                      Outlays, gross (total)

                      12
                      51

                      4180
                      Budget authority, net (total)

                      52
                      110

                      4190
                      Outlays, net (total)

                      12
                      51

             The Cures Act was enacted into law on December 13, 2016. The Cures Act authorizes $4.8 billion over 10 years for four NIH
                Innovation Projects, and includes amendments to the Public Health Service Act to advance Precision Medicine and other high
                priority NIH activities.

             10-Year Pediatric Research Initiative Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      26
                      13

                      Receipts:

                      Current law:

                      1140
                      Transfers from Presidential Election Campaign Fund

                      13

                      2000
                      Total: Balances and receipts
                      26
                      13
                      13

                      Appropriations:

                      Current law:

                      2101
                      10-Year Pediatric Research Initiative Fund
                      –13
                      –13
                      –13

                      5099
                      Balance, end of year
                      13

          Program and Financing (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      13
                      13
                      13

                      1120
                      Appropriations transferred to other accts [075–9915]
                      –13
                      –13
                      –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, $896,808,000: 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, $15,539,000 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 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: 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, $14,971,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22
                note).

             SUBSTANCE ABUSE TREATMENTFor carrying out titles III and  V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with respect to substance abuse treatment and prevention, $2,115,235,000: Provided, That in addition to amounts provided herein, $81,200,000 shall be available under section 241 of the PHS Act 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: Provided further, That none of the funds provided for section 1921 of the PHS Act shall be subject to section 241 of such Act.

             SUBSTANCE ABUSE PREVENTIONFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention, $149,703,000.

             HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
                Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act and the Protection
                and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services Administration ("SAMHSA"), $108,922,000: Provided, That in addition to amounts provided herein, $23,426,000 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(o) of the PHS Act shall remain available through September 30, 2019: 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 Assistant Secretary for Mental Health and Substance Use 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1362–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0006
                      Mental Health
                      1,133
                      1,132
                      897

                      0007
                      Substance Abuse Treatment
                      2,111
                      2,615
                      2,615

                      0008
                      Substance Abuse Prevention
                      211
                      223
                      150

                      0009
                      Health Surveillance and Program Support
                      175
                      175
                      109

                      0011
                      SAMHSA Prevention Fund
                      12
                      12

                      0100
                      Total, direct program
                      3,642
                      4,157
                      3,771

                      0799
                      Total direct obligations
                      3,642
                      4,157
                      3,771

                      0802
                      SAMHSA Reimbursables
                      117
                      117
                      117

                      0810
                      SAMHSA Reimbursable:  PHS Evaluation
                      133
                      133
                      120

                      0899
                      Total reimbursable obligations
                      250
                      250
                      237

                      0900
                      Total new obligations, unexpired accounts
                      3,892
                      4,407
                      4,008

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      1

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,634
                      3,644
                      3,271

                      1120
                      Appropriations transferred to other acct [075–0943]
                      –4

                      1121
                      Appropriations transferred from other acct [075–5627]

                      500
                      500

                      1160
                      Appropriation, discretionary (total)
                      3,630
                      4,144
                      3,771

                      Appropriations, mandatory:

                      1221
                      Appropriations transferred from the Prevention and Public Health Fund [075–0116]
                      12
                      12

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      53
                      250
                      237

                      1701
                      Change in uncollected payments, Federal sources
                      197

                      1750
                      Spending auth from offsetting collections, disc (total)
                      250
                      250
                      237

                      1900
                      Budget authority (total)
                      3,892
                      4,406
                      4,008

                      1930
                      Total budgetary resources available
                      3,893
                      4,407
                      4,008

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3,728
                      3,977
                      4,462

                      3010
                      New obligations, unexpired accounts
                      3,892
                      4,407
                      4,008

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      20

                      3020
                      Outlays (gross)
                      –3,575
                      –3,922
                      –3,925

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –88

                      3050
                      Unpaid obligations, end of year
                      3,977
                      4,462
                      4,545

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –126
                      –245
                      –245

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –197

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      78

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –245
                      –245
                      –245

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3,602
                      3,732
                      4,217

                      3200
                      Obligated balance, end of year
                      3,732
                      4,217
                      4,300

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,880
                      4,394
                      4,008

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,118
                      1,222
                      1,114

                      4011
                      Outlays from discretionary balances
                      2,417
                      2,686
                      2,803

                      4020
                      Outlays, gross (total)
                      3,535
                      3,908
                      3,917

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –131
                      –248
                      –235

                      4033
                      Non-Federal sources
                      –1
                      –2
                      –2

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –132
                      –250
                      –237

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –197

                      4052
                      Offsetting collections credited to expired accounts
                      79

                      4060
                      Additional offsets against budget authority only (total)
                      –118

                      4070
                      Budget authority, net (discretionary)
                      3,630
                      4,144
                      3,771

                      4080
                      Outlays, net (discretionary)
                      3,403
                      3,658
                      3,680

                      Mandatory:

                      4090
                      Budget authority, gross
                      12
                      12

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4

                      4101
                      Outlays from mandatory balances
                      40
                      10
                      8

                      4110
                      Outlays, gross (total)
                      40
                      14
                      8

                      4180
                      Budget authority, net (total)
                      3,642
                      4,156
                      3,771

                      4190
                      Outlays, net (total)
                      3,443
                      3,672
                      3,688

             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 075–1362–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      47
                      48
                      48

                      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
                      56
                      56

                      12.1
                      Civilian personnel benefits
                      16
                      16
                      16

                      12.2
                      Military personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      10
                      6
                      6

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      30
                      33
                      33

                      25.2
                      Other services from non-Federal sources
                      185
                      172
                      174

                      25.3
                      Other goods and services from Federal sources
                      93
                      99
                      45

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      3,246
                      3,768
                      3,434

                      99.0
                      Direct obligations
                      3,642
                      4,157
                      3,771

                      99.0
                      Reimbursable obligations
                      250
                      250
                      237

                      99.9
                      Total new obligations, unexpired accounts
                      3,892
                      4,407
                      4,008

          Employment Summary

                      Identification code 075–1362–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      462
                      455
                      451

                      1101
                      Direct military average strength employment
                      41
                      40
                      40

                      2001
                      Reimbursable civilian full-time equivalent employment
                      103
                      105
                      104

                      2101
                      Reimbursable military average strength employment
                      14
                      15
                      15

             Agency for Healthcare Research and Quality

             Federal Funds
             Healthcare research and quality
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Research on Health Costs, Quality and Outcomes
                      197
                      196

                      0002
                      Medical Expenditure Panel Survey
                      66
                      66

                      0003
                      AHRQ Program Support
                      71
                      71

                      0799
                      Total direct obligations
                      334
                      333

                      0803
                      Research on Health Costs, Quality and Outcomes (Reimbursable)
                      22
                      22

                      0899
                      Total reimbursable obligations
                      22
                      22

                      0900
                      Total new obligations, unexpired accounts
                      356
                      355

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      16
                      15
                      19

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      334
                      333

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1
                      26

                      1701
                      Change in uncollected payments, Federal sources
                      20

                      1750
                      Spending auth from offsetting collections, disc (total)
                      21
                      26

                      1900
                      Budget authority (total)
                      355
                      359

                      1930
                      Total budgetary resources available
                      371
                      374
                      19

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      15
                      19
                      19

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      392
                      382
                      411

                      3010
                      New obligations, unexpired accounts
                      356
                      355

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      2

                      3020
                      Outlays (gross)
                      –349
                      –326
                      –288

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –19

                      3050
                      Unpaid obligations, end of year
                      382
                      411
                      123

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –156
                      –85
                      –85

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –20

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      91

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –85
                      –85
                      –85

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      236
                      297
                      326

                      3200
                      Obligated balance, end of year
                      297
                      326
                      38

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      355
                      359

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      123
                      143

                      4011
                      Outlays from discretionary balances
                      218
                      183
                      288

                      4020
                      Outlays, gross (total)
                      341
                      326
                      288

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –80
                      –26

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –80
                      –26

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –20

                      4052
                      Offsetting collections credited to expired accounts
                      79

                      4060
                      Additional offsets against budget authority only (total)
                      59

                      4070
                      Budget authority, net (discretionary)
                      334
                      333

                      4080
                      Outlays, net (discretionary)
                      261
                      300
                      288

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      8

                      4180
                      Budget authority, net (total)
                      334
                      333

                      4190
                      Outlays, net (total)
                      269
                      300
                      288

              The FY 2018 Budget consolidates the Agency for Healthcare Research and Quality within the National Institutes of Health as
                the National Institute for Research on Safety and Quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      31
                      31

                      11.3
                      Other than full-time permanent
                      4
                      4

                      11.5
                      Other personnel compensation
                      1
                      1

                      11.7
                      Military personnel
                      1
                      1

                      11.9
                      Total personnel compensation
                      37
                      37

                      12.1
                      Civilian personnel benefits
                      10
                      10

                      23.1
                      Rental payments to GSA
                      4
                      4

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      10
                      10

                      25.3
                      Other goods and services from Federal sources
                      25
                      25

                      25.5
                      Research and development contracts
                      135
                      135

                      31.0
                      Equipment
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      111
                      110

                      99.0
                      Direct obligations
                      334
                      333

                      99.0
                      Reimbursable obligations
                      22
                      22

                      99.9
                      Total new obligations, unexpired accounts
                      356
                      355

          Employment Summary

                      Identification code 075–1700–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      275
                      293

                      1101
                      Direct military average strength employment
                      7
                      7

                      2001
                      Reimbursable civilian full-time equivalent employment
                      2
                      6

                      3001
                      Allocation account civilian full-time equivalent employment
                      10
                      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, $284,798,384,000, to remain available until expended.
          In addition, for carrying out such titles after May 31, 2018,  for the last quarter of fiscal year 2018 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary, to remain available until expended.
          In addition, for carrying out such titles for the first quarter of fiscal year 2019, $134,847,759,000, to remain available until expended.
          Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such
                quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0512–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments
                      372,603
                      354,194
                      384,609

                      0002
                      State and local administration
                      20,451
                      20,831
                      20,811

                      0003
                      Vaccines for Children
                      4,396
                      4,437
                      4,598

                      0799
                      Total direct obligations
                      397,450
                      379,462
                      410,018

                      0801
                      Medicare Part B premiums
                      767
                      941
                      1,026

                      0802
                      Medicare Part D

                      3
                      3

                      0899
                      Total reimbursable obligations
                      767
                      944
                      1,029

                      0900
                      Total new obligations, unexpired accounts
                      398,217
                      380,406
                      411,047

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      343
                      413
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      30,729

                      1033
                      Recoveries of prior year paid obligations
                      14

                      1050
                      Unobligated balance (total)
                      31,086
                      413
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      253,400
                      263,467
                      284,798

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      113,272
                      115,583
                      125,219

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      767
                      944
                      1,029

                      1801
                      Change in uncollected payments, Federal sources
                      105

                      1850
                      Spending auth from offsetting collections, mand (total):
                      872
                      944
                      1,029

                      1900
                      Budget authority (total)
                      367,544
                      379,994
                      411,046

                      1930
                      Total budgetary resources available
                      398,630
                      380,407
                      411,047

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      413
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      42,222
                      40,649
                      41,656

                      3010
                      New obligations, unexpired accounts
                      398,217
                      380,406
                      411,047

                      3020
                      Outlays (gross)
                      –369,061
                      –379,399
                      –408,599

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –30,729

                      3050
                      Unpaid obligations, end of year
                      40,649
                      41,656
                      44,104

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1

                      –105
                      –105

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –105

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –105
                      –105
                      –105

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      42,222
                      40,544
                      41,551

                      3200
                      Obligated balance, end of year
                      40,544
                      41,551
                      43,999

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      367,544
                      379,994
                      411,046

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      332,002
                      350,020
                      396,915

                      4101
                      Outlays from mandatory balances
                      37,059
                      29,379
                      11,684

                      4110
                      Outlays, gross (total)
                      369,061
                      379,399
                      408,599

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –767
                      –944
                      –1,029

                      4123
                      Non-Federal sources
                      –14

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –781
                      –944
                      –1,029

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –105

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      14

                      4150
                      Additional offsets against budget authority only (total)
                      –91

                      4160
                      Budget authority, net (mandatory)
                      366,672
                      379,050
                      410,017

                      4170
                      Outlays, net (mandatory)
                      368,280
                      378,455
                      407,570

                      4180
                      Budget authority, net (total)
                      366,672
                      379,050
                      410,017

                      4190
                      Outlays, net (total)
                      368,280
                      378,455
                      407,570

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      366,672
                      379,050
                      410,017

                      Outlays
                      368,280
                      378,455
                      407,570

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –3,857

                      Outlays

                      –3,857

                      Total:

                      Budget Authority
                      366,672
                      379,050
                      406,160

                      Outlays
                      368,280
                      378,455
                      403,713

             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
                         2016
                         2017
                         2018

                         Vaccine Purchase
                         4,211
                         4,241
                         4,277

                         Vaccine Stockpile
                         8
                         14
                         129

                         Ordering, Distribution, and Operations
                         132
                         133
                         141

                         Vaccine Management Contract Support
                         0
                         0
                         0

                         Evaluation Activities
                         48
                         50
                         51

                         Total Obligations
                         4,400
                         4,437
                         4,598

          Object Classification (in millions of dollars)

                      Identification code 075–0512–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      41.0
                      Direct obligations: Grants, subsidies, and contributions
                      397,450
                      379,462
                      410,018

                      99.0
                      Reimbursable obligations
                      767
                      944
                      1,029

                      99.9
                      Total new obligations, unexpired accounts
                      398,217
                      380,406
                      411,047

             Grants to States for Medicaid

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0512–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments

                      –3,857

                      0799
                      Total direct obligations

                      –3,857

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      –3,857

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –3,857

                      1900
                      Budget authority (total)

                      –3,857

                      1930
                      Total budgetary resources available

                      –3,857

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –3,857

                      3020
                      Outlays (gross)

                      3,857

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –3,857

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –3,857

                      4180
                      Budget authority, net (total)

                      –3,857

                      4190
                      Outlays, net (total)

                      –3,857

             This schedule reflects the Administration's Medicaid proposals.  This schedule reflects the Administration's Medicaid proposals.

             State Grants and Demonstrations

             Program and Financing (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0012
                      Medicaid integrity program
                      79
                      113
                      86

                      0018
                      Money follows the person (MFP) demonstration
                      1,435

                      0019
                      MFP evaluations and technical support
                      1

                      0023
                      Grants to improve outreach and enrollment
                      20
                      20

                      0025
                      Medicaid emergency psychiatric demonstration
                      1

                      0027
                      Demonstration Programs to Improve Mental Health Services
                      23

                      0799
                      Total direct obligations
                      1,559
                      133
                      86

                      0900
                      Total new obligations, unexpired accounts
                      1,559
                      133
                      86

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2,251
                      1,007
                      488

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      2

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1050
                      Unobligated balance (total)
                      2,255
                      1,007
                      488

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      597
                      84
                      86

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –38
                      –6

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –168
                      –464

                      1260
                      Appropriations, mandatory (total)
                      391
                      –386
                      86

                      1900
                      Budget authority (total)
                      391
                      –386
                      86

                      1930
                      Total budgetary resources available
                      2,646
                      621
                      574

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –80

                      1941
                      Unexpired unobligated balance, end of year
                      1,007
                      488
                      488

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      787
                      1,721
                      1,317

                      3010
                      New obligations, unexpired accounts
                      1,559
                      133
                      86

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      12

                      3020
                      Outlays (gross)
                      –559
                      –537
                      –534

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –76

                      3050
                      Unpaid obligations, end of year
                      1,721
                      1,317
                      869

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      787
                      1,721
                      1,317

                      3200
                      Obligated balance, end of year
                      1,721
                      1,317
                      869

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      391
                      –386
                      86

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      28
                      8
                      21

                      4101
                      Outlays from mandatory balances
                      531
                      529
                      513

                      4110
                      Outlays, gross (total)
                      559
                      537
                      534

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –12

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      12

                      4160
                      Budget authority, net (mandatory)
                      391
                      –386
                      86

                      4170
                      Outlays, net (mandatory)
                      547
                      537
                      534

                      4180
                      Budget authority, net (total)
                      391
                      –386
                      86

                      4190
                      Outlays, net (total)
                      547
                      537
                      534

             State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including
                the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106–170), the Medicare Prescription Drug, Improvement,
                and Modernization Act of 2003 (P.L. 108–173), the Deficit Reduction Act of 2005 (P.L. 109–171), the Children's Health Insurance
                Program Reauthorization Act of 2009 (P.L. 111–3), the Patient Protection and Affordable Care Act (P.L. 111–148), the Health
                Care and Education Reconciliation Act of 2010 (P.L. 111–152), the Protecting Access to Medicare Act of 2014 (P.L. 113–93),
                and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10).

          Object Classification (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent - Medicaid Integrity Program
                      9
                      10
                      10

                      12.1
                      Civilian personnel benefits - Medicaid Integrity Program
                      4
                      5
                      5

                      41.0
                      Grants, subsidies, and contributions - Medicaid Integrity Program
                      67
                      98
                      71

                      41.0
                      Grants, subsidies, and contributions - Money follows the person (MFP) demonstrations
                      1,435

                      41.0
                      Grants, subsidies, and contributions - MFP evaluations and technical support
                      1

                      41.0
                      Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                      20
                      20

                      41.0
                      Grants, subsidies, and contributions - Demos to Improve Mental Health
                      23

                      99.0
                      Direct obligations
                      1,559
                      133
                      86

                      99.9
                      Total new obligations, unexpired accounts
                      1,559
                      133
                      86

          Employment Summary

                      Identification code 075–0516–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      80
                      120
                      120

             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 97–248, and for administrative expenses incurred pursuant to section 201(g) of the
                Social Security Act, $323,497,300,000.
          In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
                Act that were not anticipated in budget estimates, such sums as may be necessary.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0580–0–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)
                      219,759
                      229,782
                      245,396

                      0002
                      Part D benefits (Rx Drug)
                      88,000
                      82,512
                      76,133

                      0003
                      Part D Federal administration (Rx Drug)
                      691
                      405
                      422

                      0004
                      General Fund Transfers to HI
                      1,493
                      1,324
                      1,543

                      0006
                      Federal Bureau of Investigation (HCFAC)
                      130
                      131
                      144

                      0007
                      Federal payments from taxation of OASDI benefits (HI)
                      23,022
                      24,210
                      27,425

                      0008
                      Criminal fines (HCFAC)
                      24
                      590
                      630

                      0009
                      Civil penalties and damages (HCFAC - DOJ and CMS administration)
                      24
                      32
                      33

                      0010
                      Asset Forfeiture
                      54
                      30
                      31

                      0011
                      State Low Income Determinations

                      3
                      3

                      0900
                      Total new obligations, unexpired accounts
                      333,197
                      339,019
                      351,760

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)
                      309,933
                      314,026
                      323,497

                      1200
                      Appropriation (indefinite, permanent)
                      23,027
                      24,210
                      27,425

                      1200
                      Appropriation (HCFAC for FBI)
                      130
                      131
                      144

                      1200
                      Appropriation (indefinite for HCFAC)
                      107
                      652
                      694

                      1260
                      Appropriations, mandatory (total)
                      333,197
                      339,019
                      351,760

                      1930
                      Total budgetary resources available
                      333,197
                      339,019
                      351,760

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      14,161
                      27,070
                      31,014

                      3010
                      New obligations, unexpired accounts
                      333,197
                      339,019
                      351,760

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      39

                      3020
                      Outlays (gross)
                      –319,843
                      –335,075
                      –351,776

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –484

                      3050
                      Unpaid obligations, end of year
                      27,070
                      31,014
                      30,998

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      14,161
                      27,070
                      31,014

                      3200
                      Obligated balance, end of year
                      27,070
                      31,014
                      30,998

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      333,197
                      339,019
                      351,760

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      308,597
                      309,264
                      327,237

                      4101
                      Outlays from mandatory balances
                      11,246
                      25,811
                      24,539

                      4110
                      Outlays, gross (total)
                      319,843
                      335,075
                      351,776

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –72

                      4123
                      Non-Federal sources
                      –39

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –111

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      111

                      4160
                      Budget authority, net (mandatory)
                      333,197
                      339,019
                      351,760

                      4170
                      Outlays, net (mandatory)
                      319,732
                      335,075
                      351,776

                      4180
                      Budget authority, net (total)
                      333,197
                      339,019
                      351,760

                      4190
                      Outlays, net (total)
                      319,732
                      335,075
                      351,776

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      333,197
                      339,019
                      351,760

                      Outlays
                      319,732
                      335,075
                      351,776

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –72

                      Outlays

                      –72

                      Total:

                      Budget Authority
                      333,197
                      339,019
                      351,688

                      Outlays
                      319,732
                      335,075
                      351,704

             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 075–0580–0–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      41.0
                      Grants, subsidies, and contributions
                      330,883
                      337,287
                      349,792

                      42.0
                      Insurance claims and indemnities (HI Uninsured Federal)
                      158
                      147
                      132

                      94.0
                      Financial transfers (Federal admin)
                      2,156
                      1,585
                      1,836

                      99.9
                      Total new obligations, unexpired accounts
                      333,197
                      339,019
                      351,760

             Payments to Health Care Trust Funds

             (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0580–2–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)

                      –72

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      –72

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)

                      –72

                      1930
                      Total budgetary resources available

                      –72

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –72

                      3020
                      Outlays (gross)

                      72

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –72

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –72

                      4180
                      Budget authority, net (total)

                      –72

                      4190
                      Outlays, net (total)

                      –72

             Quality Improvement Organizations

             Program and Financing (in millions of dollars)

                      Identification code 075–0519–0–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      QIO contracts
                      696
                      389
                      622

                      0002
                      QIO support contracts
                      167
                      167
                      184

                      0900
                      Total new obligations, unexpired accounts
                      863
                      556
                      806

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      38
                      556
                      806

                      1801
                      Change in uncollected payments, Federal sources
                      922

                      1850
                      Spending auth from offsetting collections, mand (total)
                      960
                      556
                      806

                      1930
                      Total budgetary resources available
                      960
                      556
                      806

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –97

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,488
                      1,519
                      1,519

                      3010
                      New obligations, unexpired accounts
                      863
                      556
                      806

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      5

                      3020
                      Outlays (gross)
                      –776
                      –556
                      –806

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –61

                      3050
                      Unpaid obligations, end of year
                      1,519
                      1,519
                      1,519

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –2,431
                      –2,488
                      –2,488

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –922

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      865

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –2,488
                      –2,488
                      –2,488

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –943
                      –969
                      –969

                      3200
                      Obligated balance, end of year
                      –969
                      –969
                      –969

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      960
                      556
                      806

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      141
                      145
                      396

                      4101
                      Outlays from mandatory balances
                      635
                      411
                      410

                      4110
                      Outlays, gross (total)
                      776
                      556
                      806

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –682
                      –556
                      –806

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –922

                      4142
                      Offsetting collections credited to expired accounts
                      644

                      4150
                      Additional offsets against budget authority only (total)
                      –278

                      4170
                      Outlays, net (mandatory)
                      94

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      94

                      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 075–0519–0–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      30
                      21
                      30

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      803
                      514
                      745

                      25.3
                      Other goods and services from Federal sources
                      18
                      14
                      21

                      25.4
                      Operation and maintenance of facilities
                      11
                      6
                      9

                      99.9
                      Total new obligations, unexpired accounts
                      863
                      556
                      806

          Employment Summary

                      Identification code 075–0519–0–1–571
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      208
                      232
                      232

             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 $3,587,996,000, 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 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 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 2018 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations
                with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0511–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Program operations
                      3,022
                      3,041
                      2,698

                      0002
                      Federal administration
                      763
                      763
                      735

                      0003
                      State survey and certification
                      410
                      420
                      429

                      0004
                      Research, demonstrations, and evaluation projects
                      85
                      31
                      29

                      0007
                      ARRA Medicare/Medicaid HIT
                      86
                      23
                      23

                      0008
                      Risk Corridor
                      5,400
                      5,917

                      0100
                      Total direct program
                      9,766
                      10,195
                      3,914

                      0799
                      Total direct obligations
                      9,766
                      10,195
                      3,914

                      0801
                      Clinical laboratory improvement amendments
                      53
                      47
                      50

                      0802
                      Sale of data
                      10
                      8
                      8

                      0803
                      Coordination of benefits
                      30
                      28
                      30

                      0804
                      Medicare advantage/Prescription drug plan
                      80
                      81
                      80

                      0805
                      Provider enrollment
                      12
                      24
                      25

                      0806
                      Recovery audit contractors
                      105
                      105
                      563

                      0808
                      Marketplace User Fees
                      1,129
                      1,239
                      1,170

                      0810
                      Risk Adjustment Administrative Expenses
                      5
                      25
                      18

                      0813
                      Other reimbursable program activity
                      206
                      29
                      21

                      0899
                      Total reimbursable obligations
                      1,630
                      1,586
                      1,965

                      0900
                      Total new obligations, unexpired accounts
                      11,396
                      11,781
                      5,879

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      –1,091
                      –5,574
                      –11,967

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      52
                      –517

                      1021
                      Recoveries of prior year unpaid obligations
                      32

                      1033
                      Recoveries of prior year paid obligations
                      11

                      1050
                      Unobligated balance (total)
                      –996
                      –6,091
                      –11,967

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      68
                      3
                      3

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –5

                      1260
                      Appropriations, mandatory (total)
                      63
                      3
                      3

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      2,391
                      4,079
                      3,725

                      1701
                      Change in uncollected payments, Federal sources
                      2,172

                      1750
                      Spending auth from offsetting collections, disc (total)
                      4,563
                      4,079
                      3,725

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1,580
                      1,862
                      2,052

                      1801
                      Change in uncollected payments, Federal sources
                      674

                      1802
                      Offsetting collections (previously unavailable)
                      75
                      86
                      99

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –94
                      –125

                      1850
                      Spending auth from offsetting collections, mand (total)
                      2,235
                      1,823
                      2,151

                      1900
                      Budget authority (total)
                      6,861
                      5,905
                      5,879

                      1930
                      Total budgetary resources available
                      5,865
                      –186
                      –6,088

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –43

                      1941
                      Unexpired unobligated balance, end of year
                      –5,574
                      –11,967
                      –11,967

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      6,739
                      12,072
                      17,944

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      517

                      3010
                      New obligations, unexpired accounts
                      11,396
                      11,781
                      5,879

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      103

                      3020
                      Outlays (gross)
                      –5,948
                      –6,426
                      –6,117

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –32

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –186

                      3050
                      Unpaid obligations, end of year
                      12,072
                      17,944
                      17,706

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5,011
                      –5,470
                      –5,470

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,846

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2,387

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –5,470
                      –5,470
                      –5,470

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,728
                      7,119
                      12,474

                      3200
                      Obligated balance, end of year
                      6,602
                      12,474
                      12,236

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,563
                      4,079
                      3,725

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,055
                      4,079
                      3,725

                      4011
                      Outlays from discretionary balances
                      2,270

                      4020
                      Outlays, gross (total)
                      4,325
                      4,079
                      3,725

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –4,252
                      –4,071
                      –3,691

                      4033
                      Non-Federal sources
                      –378
                      –8
                      –34

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,630
                      –4,079
                      –3,725

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,172

                      4052
                      Offsetting collections credited to expired accounts
                      2,239

                      4060
                      Additional offsets against budget authority only (total)
                      67

                      4080
                      Outlays, net (discretionary)
                      –305

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,298
                      1,826
                      2,154

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      452
                      1,956
                      2,154

                      4101
                      Outlays from mandatory balances
                      1,171
                      391
                      238

                      4110
                      Outlays, gross (total)
                      1,623
                      2,347
                      2,392

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –222
                      –240
                      –189

                      4123
                      Non-Federal sources
                      –1,372
                      –1,622
                      –1,863

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –1,594
                      –1,862
                      –2,052

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –674

                      4142
                      Offsetting collections credited to expired accounts
                      3

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      11

                      4150
                      Additional offsets against budget authority only (total)
                      –660

                      4160
                      Budget authority, net (mandatory)
                      44
                      –36
                      102

                      4170
                      Outlays, net (mandatory)
                      29
                      485
                      340

                      4180
                      Budget authority, net (total)
                      44
                      –36
                      102

                      4190
                      Outlays, net (total)
                      –276
                      485
                      340

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      130
                      148
                      187

                      5091
                      Expiring unavailable balance: Offsetting collections
                      –1

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      148
                      187
                      88

                      5093
                      Expired unavailable balance, SOY: Offsetting collections
                      59
                      60
                      60

                      5095
                      Expired unavailable balance, EOY: Offsetting collections
                      59
                      60
                      60

             Note: The figure for the risk corridors program in this table for fiscal year 2017 is not an estimate. Amounts for fiscal
                year 2017 are uncertain and therefore the figure in this table simply reflects imbalances between payments out and payments
                in by participating plans equal to those that occurred for fiscal year 2016.

             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 075–0511–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      459
                      464
                      464

                      11.3
                      Other than full-time permanent
                      12
                      22
                      11

                      11.5
                      Other personnel compensation
                      7
                      8
                      8

                      11.7
                      Military personnel
                      14
                      14
                      14

                      11.9
                      Total personnel compensation
                      492
                      508
                      497

                      12.1
                      Civilian personnel benefits
                      162
                      146
                      147

                      12.2
                      Military personnel benefits
                      7
                      7
                      7

                      21.0
                      Travel and transportation of persons
                      5
                      3
                      5

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      19

                      23.3
                      Communications, utilities, and miscellaneous charges
                      74
                      74
                      74

                      24.0
                      Printing and reproduction
                      58
                      58
                      58

                      25.2
                      Other services from non-Federal sources
                      2,836
                      2,065
                      1,646

                      25.3
                      Other goods and services from Federal sources
                      87
                      3
                      3

                      25.6
                      Medical care
                      485
                      1,275
                      1,338

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1

                      31.0
                      Equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      136
                      136
                      136

                      42.0
                      Insurance claims and indemnities
                      5,400
                      5,917

                      99.0
                      Direct obligations
                      9,765
                      10,195
                      3,914

                      99.0
                      Reimbursable obligations
                      1,631
                      1,586
                      1,965

                      99.9
                      Total new obligations, unexpired accounts
                      11,396
                      11,781
                      5,879

          Employment Summary

                      Identification code 075–0511–0–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4,329
                      4,387
                      4,232

                      1001
                      Direct civilian full-time equivalent employment
                      159
                      166
                      164

                      1101
                      Direct military average strength employment
                      189
                      138
                      138

                      2001
                      Reimbursable civilian full-time equivalent employment
                      188
                      267
                      267

             Program Management

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0511–4–1–550
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      ACL SHIPs

                      13

                      0899
                      Total reimbursable obligations

                      13

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)

                      13

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      13

                      1900
                      Budget authority (total)

                      13

                      1930
                      Total budgetary resources available

                      13

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      13

                      3020
                      Outlays (gross)

                      –13

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      13

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      13

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –13

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Children's Health Insurance Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0515–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Grants to states and US territories
                      14,062
                      15,952
                      5,700

                      0003
                      Child health quality
                      7
                      16
                      17

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      14,069
                      15,968
                      5,717

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      7,502
                      3,014
                      6,955

                      1011
                      Unobligated balance transfer from other acct [075–5551]

                      3,656
                      570

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      216
                      186
                      104

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1050
                      Unobligated balance (total)
                      7,720
                      6,856
                      7,629

                      Budget authority:

                      Appropriations, discretionary:

                      1120
                      Appropriations transferred to other acct [075–5551]

                      –570

                      1131
                      Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310

                      –542
                      –3,279

                      1131
                      Unobligated balance of appropriations permanently reduced, Perf. Bonus Pmts.

                      –5,669
                      –1,193

                      1160
                      Appropriation, discretionary (total):

                      –6,781
                      –4,472

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      19,320
                      20,400
                      5,700

                      1221
                      Appropriations transferred from other acct [075–5551]

                      2,618
                      570

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –4,679
                      –170

                      1260
                      Appropriations, mandatory (total)
                      14,641
                      22,848
                      6,270

                      1900
                      Budget authority (total)
                      14,641
                      16,067
                      1,798

                      1930
                      Total budgetary resources available
                      22,361
                      22,923
                      9,427

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –5,278

                      1941
                      Unexpired unobligated balance, end of year
                      3,014
                      6,955
                      3,710

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      8,722
                      8,069
                      7,382

                      3010
                      New obligations, unexpired accounts
                      14,069
                      15,968
                      5,717

                      3020
                      Outlays (gross)
                      –14,305
                      –16,655
                      –12,017

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –415

                      3050
                      Unpaid obligations, end of year
                      8,069
                      7,382
                      1,082

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      8,722
                      8,069
                      7,382

                      3200
                      Obligated balance, end of year
                      8,069
                      7,382
                      1,082

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –6,781
                      –4,472

                      Mandatory:

                      4090
                      Budget authority, gross
                      14,641
                      22,848
                      6,270

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6,194
                      8,300
                      5,700

                      4101
                      Outlays from mandatory balances
                      8,111
                      8,355
                      6,317

                      4110
                      Outlays, gross (total)
                      14,305
                      16,655
                      12,017

                      4180
                      Budget authority, net (total)
                      14,641
                      16,067
                      1,798

                      4190
                      Outlays, net (total)
                      14,305
                      16,655
                      12,017

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      14,641
                      16,067
                      1,798

                      Outlays
                      14,305
                      16,655
                      12,017

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      1,400

                      Outlays

                      1,400

                      Total:

                      Budget Authority
                      14,641
                      16,067
                      3,198

                      Outlays
                      14,305
                      16,655
                      13,417

             The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under title XXI of the Social Security
                Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income
                families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured children through a separate
                CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization
                Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through fiscal year 2013.
                CHIPRA made some modifications to the program, including increased funding for States and territories, bonus payments for
                States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency
                fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding
                is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding
                for CHIP, providing appropriations through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L.
                114–10, MACRA) extended funding for CHIP for two years, through fiscal year 2017. The Budget proposes a two-year extension
                of CHIP funding through fiscal year 2019.

             Children's Health Insurance Fund

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0515–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      1,400

                      1930
                      Total budgetary resources available

                      1,400

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      1,400

                      Change in obligated balance:

                      Unpaid obligations:

                      3020
                      Outlays (gross)

                      –1,400

                      3050
                      Unpaid obligations, end of year

                      –1,400

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –1,400

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      1,400

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1,400

                      4180
                      Budget authority, net (total)

                      1,400

                      4190
                      Outlays, net (total)

                      1,400

             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 075–0522–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Administration
                      282
                      353
                      330

                      0002
                      Innovation Activities
                      1,011
                      1,137
                      1,063

                      0900
                      Total new obligations, unexpired accounts
                      1,293
                      1,490
                      1,393

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      5,669
                      4,404
                      2,914

                      1021
                      Recoveries of prior year unpaid obligations
                      28

                      1050
                      Unobligated balance (total)
                      5,697
                      4,404
                      2,914

                      1930
                      Total budgetary resources available
                      5,697
                      4,404
                      2,914

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      4,404
                      2,914
                      1,521

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,482
                      1,591
                      1,787

                      3010
                      New obligations, unexpired accounts
                      1,293
                      1,490
                      1,393

                      3020
                      Outlays (gross)
                      –1,156
                      –1,294
                      –1,408

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –28

                      3050
                      Unpaid obligations, end of year
                      1,591
                      1,787
                      1,772

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,482
                      1,591
                      1,787

                      3200
                      Obligated balance, end of year
                      1,591
                      1,787
                      1,772

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      1,156
                      1,294
                      1,408

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      1,156
                      1,294
                      1,408

             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 075–0522–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      56
                      69
                      70

                      12.1
                      Civilian personnel benefits
                      18
                      21
                      22

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      4
                      3

                      25.2
                      Other services from non-Federal sources
                      644
                      670
                      623

                      41.0
                      Grants, subsidies, and contributions
                      464
                      615
                      572

                      42.0
                      Insurance claims and indemnities
                      109
                      111
                      103

                      99.9
                      Total new obligations, unexpired accounts
                      1,293
                      1,490
                      1,393

          Employment Summary

                      Identification code 075–0522–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      521
                      615
                      617

             Child Enrollment Contingency Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      2,048
                      577

                      Receipts:

                      Current law:

                      1140
                      Interest, Child Enrollment Contingency Fund
                      20
                      7

                      2000
                      Total: Balances and receipts
                      20
                      2,055
                      577

                      Appropriations:

                      Current law:

                      2101
                      Child Enrollment Contingency Fund
                      –20

                      2103
                      Child Enrollment Contingency Fund

                      –2,048
                      –570

                      2132
                      Child Enrollment Contingency Fund
                      2,048

                      2134
                      Child Enrollment Contingency Fund

                      570

                      2199
                      Total current law appropriations
                      2,028
                      –1,478
                      –570

                      2999
                      Total appropriations
                      2,028
                      –1,478
                      –570

                      5099
                      Balance, end of year
                      2,048
                      577
                      7

          Program and Financing (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Grants to States and US Territories
                      224

                      0900
                      Total new obligations (object class 41.0)
                      224

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2,048
                      3,656
                      570

                      1010
                      Unobligated balance transfer to other accts [075–0515]

                      –3,656
                      –570

                      1050
                      Unobligated balance (total)
                      2,048

                      Budget authority:

                      Appropriations, discretionary:

                      1121
                      Delay of transfer to other acct [075–0515]

                      570

                      1134
                      Appropriations precluded from obligation

                      –570

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3,860
                      1,140

                      1201
                      Appropriation (special or trust fund)
                      20

                      1203
                      Appropriation (previously unavailable)

                      2,048
                      570

                      1220
                      Appropriations transferred to other acct [075–0515]

                      –2,618
                      –570

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –2,048

                      1260
                      Appropriations, mandatory (total)
                      1,832
                      570

                      1900
                      Budget authority (total)
                      1,832
                      570

                      1930
                      Total budgetary resources available
                      3,880
                      570

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3,656
                      570

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      53
                      224

                      3010
                      New obligations, unexpired accounts
                      224

                      3020
                      Outlays (gross)
                      –53
                      –224

                      3050
                      Unpaid obligations, end of year
                      224

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      53
                      224

                      3200
                      Obligated balance, end of year
                      224

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,832
                      570

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      53
                      224

                      4180
                      Budget authority, net (total)
                      1,832
                      570

                      4190
                      Outlays, net (total)
                      53
                      224

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      2,053
                      571
                      578

                      5001
                      Total investments, EOY: Federal securities: Par value
                      571
                      578

             The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3, CHIPRA) established the Child Enrollment
                Contingency Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund
                payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target
                average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended
                the Contingency Fund through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended
                the Contingency Fund through fiscal year 2017. The Budget proposes a two-year extension of CHIP funding, including an extension
                of the Contingency Fund through fiscal year 2019.

             The Fund received an initial appropriation equal to 20 percent of the fiscal year 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 075–0508–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Incentive payments to hospitals
                      1,822
                      462
                      15

                      0802
                      Incentive payments to eligible professionals
                      972
                      460

                      0900
                      Total new obligations (object class 42.0)
                      2,794
                      922
                      15

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected from the HI Trust Fund
                      1,845
                      462
                      15

                      1800
                      Collected from the SMI Trust Fund
                      930
                      460

                      1801
                      Change in uncollected payments, Federal sources
                      19

                      1850
                      Spending auth from offsetting collections, mand (total)
                      2,794
                      922
                      15

                      1930
                      Total budgetary resources available
                      2,794
                      922
                      15

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      51
                      80
                      80

                      3010
                      New obligations, unexpired accounts
                      2,794
                      922
                      15

                      3020
                      Outlays (gross)
                      –2,765
                      –922
                      –15

                      3050
                      Unpaid obligations, end of year
                      80
                      80
                      80

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –227
                      –246
                      –246

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –19

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –246
                      –246
                      –246

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –176
                      –166
                      –166

                      3200
                      Obligated balance, end of year
                      –166
                      –166
                      –166

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,794
                      922
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2,765
                      846
                      15

                      4101
                      Outlays from mandatory balances

                      76

                      4110
                      Outlays, gross (total)
                      2,765
                      922
                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –2,775
                      –922
                      –15

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –19

                      4170
                      Outlays, net (mandatory)
                      –10

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –10

                      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 075–0112–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Premium rate review grants

                      26

                      0900
                      Total new obligations (object class 41.0)

                      26

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      7
                      29
                      8

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      22

                      1021
                      Recoveries of prior year unpaid obligations

                      5
                      25

                      1050
                      Unobligated balance (total)
                      29
                      34
                      33

                      1930
                      Total budgetary resources available
                      29
                      34
                      33

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      29
                      8
                      33

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      105
                      71
                      64

                      3010
                      New obligations, unexpired accounts

                      26

                      3020
                      Outlays (gross)
                      –29
                      –28
                      –26

                      3040
                      Recoveries of prior year unpaid obligations, unexpired

                      –5
                      –25

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –5

                      3050
                      Unpaid obligations, end of year
                      71
                      64
                      13

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      105
                      71
                      64

                      3200
                      Obligated balance, end of year
                      71
                      64
                      13

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      29
                      28
                      26

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      29
                      28
                      26

             The Patient Protection and Affordable Care Act (P.L. 111–148) 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 consistent with Section 2794 (c)(2)(B).

             Pre-Existing Condition Insurance Plan Program

             Program and Financing (in millions of dollars)

                      Identification code 075–0113–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Pre-Existing Condition Insurance Plan Program (Direct)
                      1

                      0002
                      Administration

                      75

                      0799
                      Total direct obligations
                      1
                      75

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)
                      1
                      75

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      173
                      389
                      322

                      1021
                      Recoveries of prior year unpaid obligations
                      217
                      8

                      1050
                      Unobligated balance (total)
                      390
                      397
                      322

                      1930
                      Total budgetary resources available
                      390
                      397
                      322

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      389
                      322
                      322

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      231
                      15

                      3010
                      New obligations, unexpired accounts
                      1
                      75

                      3020
                      Outlays (gross)

                      –82

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –217
                      –8

                      3050
                      Unpaid obligations, end of year
                      15

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      231
                      15

                      3200
                      Obligated balance, end of year
                      15

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      82

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      82

             This account funds the Pre-Existing Condition Insurance Plan program (PCIP), which made health insurance available to people
                who had been unable to purchase insurance due to a pre-existing condition. Enrollees paid 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.
                111–148). The PCIP program ended in fiscal year 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, as well as allowable
                administrative costs in the current year.

             Early Retiree Reinsurance Program

             Program and Financing (in millions of dollars)

                      Identification code 075–0114–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      26
                      26
                      26

                      1930
                      Total budgetary resources available
                      26
                      26
                      26

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      26
                      26
                      26

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      11
                      11
                      5

                      3020
                      Outlays (gross)

                      –6
                      –5

                      3050
                      Unpaid obligations, end of year
                      11
                      5

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      11
                      11
                      5

                      3200
                      Obligated balance, end of year
                      11
                      5

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      6
                      5

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      6
                      5

             The Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated $5 billion for the Early Retiree
                Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
                sponsors.

             Affordable Insurance Exchange Grants

             Program and Financing (in millions of dollars)

                      Identification code 075–0115–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0002
                      Administration
                      20
                      24
                      17

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      22
                      26
                      17

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –2
                      –2

                      1260
                      Appropriations, mandatory (total)
                      20
                      24
                      17

                      1930
                      Total budgetary resources available
                      20
                      24
                      17

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,005
                      342
                      79

                      3010
                      New obligations, unexpired accounts
                      20
                      24
                      17

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1

                      3020
                      Outlays (gross)
                      –446
                      –287
                      –59

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –238

                      3050
                      Unpaid obligations, end of year
                      342
                      79
                      37

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,005
                      342
                      79

                      3200
                      Obligated balance, end of year
                      342
                      79
                      37

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      20
                      24
                      17

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11
                      7
                      5

                      4101
                      Outlays from mandatory balances
                      435
                      280
                      54

                      4110
                      Outlays, gross (total)
                      446
                      287
                      59

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      2

                      4160
                      Budget authority, net (mandatory)
                      20
                      24
                      17

                      4170
                      Outlays, net (mandatory)
                      444
                      287
                      59

                      4180
                      Budget authority, net (total)
                      20
                      24
                      17

                      4190
                      Outlays, net (total)
                      444
                      287
                      59

             This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
                Exchanges. The Exchanges 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. 111–148) provided amounts necessary to enable the Secretary to award
                grants to States beginning no later than March 23, 2011, and allowed for renewal of 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 075–0115–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      4
                      5
                      5

                      25.2
                      Other services from non-Federal sources
                      16
                      19
                      12

                      99.9
                      Total new obligations, unexpired accounts
                      20
                      24
                      17

          Employment Summary

                      Identification code 075–0115–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      34
                      34
                      34

             Risk Adjustment Program Payments

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      174
                      248
                      332

                      Receipts:

                      Current law:

                      1110
                      Receipts, Risk Adjustment Program
                      3,619
                      4,806
                      6,361

                      2000
                      Total: Balances and receipts
                      3,793
                      5,054
                      6,693

                      Appropriations:

                      Current law:

                      2101
                      Risk Adjustment Program Payments
                      –3,618
                      –4,807
                      –6,361

                      2103
                      Risk Adjustment Program Payments
                      –174
                      –247
                      –332

                      2132
                      Risk Adjustment Program Payments
                      247
                      332

                      2199
                      Total current law appropriations
                      –3,545
                      –4,722
                      –6,693

                      2999
                      Total appropriations
                      –3,545
                      –4,722
                      –6,693

                      5099
                      Balance, end of year
                      248
                      332

          Program and Financing (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Risk Adjustment Program Payments (Direct)
                      3,545
                      4,722
                      6,693

                      0900
                      Total new obligations (object class 41.0)
                      3,545
                      4,722
                      6,693

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      3,618
                      4,807
                      6,361

                      1203
                      Appropriation (previously unavailable)
                      174
                      247
                      332

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –247
                      –332

                      1260
                      Appropriations, mandatory (total)
                      3,545
                      4,722
                      6,693

                      1930
                      Total budgetary resources available
                      3,545
                      4,722
                      6,693

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      442
                      1,247
                      1,232

                      3010
                      New obligations, unexpired accounts
                      3,545
                      4,722
                      6,693

                      3020
                      Outlays (gross)
                      –2,740
                      –4,737
                      –6,693

                      3050
                      Unpaid obligations, end of year
                      1,247
                      1,232
                      1,232

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      442
                      1,247
                      1,232

                      3200
                      Obligated balance, end of year
                      1,247
                      1,232
                      1,232

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      3,545
                      4,722
                      6,693

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2,128
                      3,552
                      6,693

                      4101
                      Outlays from mandatory balances
                      612
                      1,185

                      4110
                      Outlays, gross (total)
                      2,740
                      4,737
                      6,693

                      4180
                      Budget authority, net (total)
                      3,545
                      4,722
                      6,693

                      4190
                      Outlays, net (total)
                      2,740
                      4,737
                      6,693

             Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a permanent risk adjustment program
                for non-grandfathered plans in the individual and small group markets. Charges are collected from health insurance issuers
                that enroll healthier than average enrollees and payments are made to issuers that enroll sicker than average enrollees. Risk
                adjustment may be operated by a State, or by the Federal government in the event a State chooses not to operate risk adjustment.
                Payments and charges are made in the year following the plan year for which they are calculated.

             Transitional Reinsurance Program

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      649
                      455
                      273

                      Receipts:

                      Current law:

                      1110
                      Contributions, Transitional Reinsurance Program
                      6,713
                      3,978
                      167

                      2000
                      Total: Balances and receipts
                      7,362
                      4,433
                      440

                      Appropriations:

                      Current law:

                      2101
                      Transitional Reinsurance Program
                      –6,713
                      –3,978
                      –166

                      2103
                      Transitional Reinsurance Program
                      –650
                      –456
                      –274

                      2132
                      Transitional Reinsurance Program
                      456
                      274

                      2199
                      Total current law appropriations
                      –6,907
                      –4,160
                      –440

                      2999
                      Total appropriations
                      –6,907
                      –4,160
                      –440

                      5099
                      Balance, end of year
                      455
                      273

          Program and Financing (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Transitional reinsurance payments
                      7,847
                      4,151
                      435

                      0002
                      Administrative expenses

                      9
                      6

                      0900
                      Total new obligations, unexpired accounts
                      7,847
                      4,160
                      441

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      941
                      1
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      6,713
                      3,978
                      166

                      1203
                      Appropriation (previously unavailable)
                      650
                      456
                      274

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –456
                      –274

                      1260
                      Appropriations, mandatory (total)
                      6,907
                      4,160
                      440

                      1930
                      Total budgetary resources available
                      7,848
                      4,161
                      441

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      224
                      1

                      3010
                      New obligations, unexpired accounts
                      7,847
                      4,160
                      441

                      3020
                      Outlays (gross)
                      –7,623
                      –4,383
                      –440

                      3050
                      Unpaid obligations, end of year
                      224
                      1
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      224
                      1

                      3200
                      Obligated balance, end of year
                      224
                      1
                      2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      6,907
                      4,160
                      440

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6,033
                      4,160
                      440

                      4101
                      Outlays from mandatory balances
                      1,590
                      223

                      4110
                      Outlays, gross (total)
                      7,623
                      4,383
                      440

                      4180
                      Budget authority, net (total)
                      6,907
                      4,160
                      440

                      4190
                      Outlays, net (total)
                      7,623
                      4,383
                      440

             Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111–148) 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 for the 2016 plan year, the final year of the program, will be announced
                in June of 2017.

          Object Classification (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      41.0
                      Grants, subsidies, and contributions - Transitional Reinsurance
                      7,847
                      4,151
                      435

                      41.0
                      Grants, subsidies, and contributions - Administration

                      9
                      6

                      99.9
                      Total new obligations, unexpired accounts
                      7,847
                      4,160
                      441

             Consumer Operated and Oriented Plan Program Contingency Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0524–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      89
                      16

                      0706
                      Interest on reestimates of direct loan subsidy
                      4
                      1

                      0709
                      Administrative expenses
                      2
                      1

                      0900
                      Total new obligations, unexpired accounts
                      95
                      18

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      93
                      17

                      1930
                      Total budgetary resources available
                      96
                      18

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      69
                      16
                      2

                      3010
                      New obligations, unexpired accounts
                      95
                      18

                      3020
                      Outlays (gross)
                      –148
                      –32
                      –1

                      3050
                      Unpaid obligations, end of year
                      16
                      2
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      69
                      16
                      2

                      3200
                      Obligated balance, end of year
                      16
                      2
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      93
                      17

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      93
                      17

                      4101
                      Outlays from mandatory balances
                      55
                      15
                      1

                      4110
                      Outlays, gross (total)
                      148
                      32
                      1

                      4180
                      Budget authority, net (total)
                      93
                      17

                      4190
                      Outlays, net (total)
                      148
                      32
                      1

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

                      Identification code 075–0524–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct loan subsidy outlays:

                      134002
                      Solvency Loans
                      48
                      13

                      134999
                      Total subsidy outlays
                      48
                      13

                      Direct loan reestimates:

                      135001
                      Startup Loans
                      4
                      –8

                      135002
                      Solvency Loans
                      88
                      5

                      135999
                      Total direct loan reestimates
                      92
                      –3

                      Administrative expense data:

                      3580
                      Outlays from balances
                      7
                      2
                      1

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

          Object Classification (in millions of dollars)

                      Identification code 075–0524–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.2
                      Other services from non-Federal sources
                      2
                      1

                      41.0
                      Grants, subsidies, and contributions
                      93
                      17

                      99.9
                      Total new obligations, unexpired accounts
                      95
                      18

             Consumer Operated and Oriented Plan Program Account

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      7
                      7
                      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 075–0118–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      430
                      74

                      0706
                      Interest on reestimates of direct loan subsidy
                      46
                      7

                      0709
                      Administrative expenses
                      5
                      1

                      0900
                      Total new obligations, unexpired accounts
                      481
                      82

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      6
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      476
                      81

                      1930
                      Total budgetary resources available
                      482
                      82

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      98
                      2
                      2

                      3010
                      New obligations, unexpired accounts
                      481
                      82

                      3020
                      Outlays (gross)
                      –577
                      –82
                      –1

                      3050
                      Unpaid obligations, end of year
                      2
                      2
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      98
                      2
                      2

                      3200
                      Obligated balance, end of year
                      2
                      2
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      476
                      81

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      476
                      81

                      4101
                      Outlays from mandatory balances
                      101
                      1
                      1

                      4110
                      Outlays, gross (total)
                      577
                      82
                      1

                      4180
                      Budget authority, net (total)
                      476
                      81

                      4190
                      Outlays, net (total)
                      577
                      82
                      1

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

                      Identification code 075–0118–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct loan subsidy outlays:

                      134003
                      Solvency  Loans
                      96
                      1

                      134999
                      Total subsidy outlays
                      96
                      1

                      Direct loan reestimates:

                      135002
                      Startup Loans
                      57
                      –65

                      135003
                      Solvency  Loans
                      416
                      38

                      135999
                      Total direct loan reestimates
                      473
                      –27

                      Administrative expense data:

                      3580
                      Outlays from balances
                      5

                      1

             Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the
                Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
                insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
                markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves
                which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of
                encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section
                1322.

          Object Classification (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      2

                      25.2
                      Other services from non-Federal sources
                      1

                      25.3
                      Other goods and services from Federal sources
                      2
                      1

                      41.0
                      Grants, subsidies, and contributions
                      476
                      81

                      99.9
                      Total new obligations, unexpired accounts
                      481
                      82

          Employment Summary

                      Identification code 075–0118–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      18

             Consumer Operated and Oriented Plan Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      23
                      33
                      33

                      0742
                      Downward reestimates paid to receipt accounts
                      3
                      99

                      0743
                      Interest on downward reestimates

                      8

                      0900
                      Total new obligations, unexpired accounts
                      26
                      140
                      33

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      523

                      1023
                      Unobligated balances applied to repay debt

                      –523

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      16

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      629
                      148
                      110

                      1801
                      Change in uncollected payments, Federal sources
                      –96
                      –1

                      1825
                      Spending authority from offsetting collections applied to repay debt

                      –7
                      –77

                      1850
                      Spending auth from offsetting collections, mand (total)
                      533
                      140
                      33

                      1900
                      Budget authority (total)
                      549
                      140
                      33

                      1930
                      Total budgetary resources available
                      549
                      140
                      33

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      523

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      226
                      4
                      1

                      3010
                      New obligations, unexpired accounts
                      26
                      140
                      33

                      3020
                      Outlays (gross)
                      –248
                      –143
                      –33

                      3050
                      Unpaid obligations, end of year
                      4
                      1
                      1

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –97
                      –1

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      96
                      1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      129
                      3
                      1

                      3200
                      Obligated balance, end of year
                      3
                      1
                      1

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      549
                      140
                      33

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      248
                      143
                      33

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –572
                      –82

                      4122
                      Interest on uninvested funds
                      –12
                      –12
                      –12

                      4123
                      Non-Federal sources
                      –45
                      –54
                      –98

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –629
                      –148
                      –110

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      96
                      1

                      4160
                      Budget authority, net (mandatory)
                      16
                      –7
                      –77

                      4170
                      Outlays, net (mandatory)
                      –381
                      –5
                      –77

                      4180
                      Budget authority, net (total)
                      16
                      –7
                      –77

                      4190
                      Outlays, net (total)
                      –381
                      –5
                      –77

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      1,727
                      1,909
                      1,858

                      1231
                      Disbursements: Direct loan disbursements
                      222
                      3

                      1251
                      Repayments: Repayments and prepayments
                      –45
                      –54
                      –98

                      1263
                      Write-offs for default: Direct loans
                      5

                      1290
                      Outstanding, end of year
                      1,909
                      1,858
                      1,760

          Balance Sheet (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2015 actual
                      2016 actual

                      Group heading

                      ASSETS:

                      Federal assets:

                      1101
                      Fund balances with Treasury
                      68
                      506

                      Investments in US securities:

                      1106
                      Receivables, net
                      79
                      81

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      1,727
                      1,909

                      1402
                      Interest receivable

                      12

                      1405
                      Allowance for subsidy cost (-)
                      –813
                      –1,284

                      1499
                      Net present value of assets related to direct loans
                      914
                      637

                      1999
                      Total assets
                      1,061
                      1,224

                      LIABILITIES:

                      2103
                      Federal liabilities: Debt
                      1,061
                      1,224

                      4999
                      Total liabilities and net position
                      1,061
                      1,224

             Consumer Operated and Oriented Plan Program Contingency Fund Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      6
                      9
                      9

                      0742
                      Downward reestimates paid to receipt accounts

                      19

                      0743
                      Interest on downward reestimates

                      1

                      0900
                      Total new obligations, unexpired accounts
                      6
                      29
                      9

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      102
                      1

                      1023
                      Unobligated balances applied to repay debt

                      –101

                      1050
                      Unobligated balance (total)

                      1
                      1

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      4
                      4
                      5

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      152
                      41
                      17

                      1801
                      Change in uncollected payments, Federal sources
                      –48
                      –14

                      1825
                      Spending authority from offsetting collections applied to repay debt

                      –2
                      –14

                      1850
                      Spending auth from offsetting collections, mand (total)
                      104
                      25
                      3

                      1900
                      Budget authority (total)
                      108
                      29
                      8

                      1930
                      Total budgetary resources available
                      108
                      30
                      9

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      102
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      148
                      33
                      2

                      3010
                      New obligations, unexpired accounts
                      6
                      29
                      9

                      3020
                      Outlays (gross)
                      –121
                      –60
                      –9

                      3050
                      Unpaid obligations, end of year
                      33
                      2
                      2

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –62
                      –14

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      48
                      14

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –14

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      86
                      19
                      2

                      3200
                      Obligated balance, end of year
                      19
                      2
                      2

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      108
                      29
                      8

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      121
                      60
                      9

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –141
                      –30

                      4122
                      Interest on uninvested funds
                      –3
                      –4
                      –3

                      4123
                      Non-Federal sources
                      –8
                      –7
                      –14

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –152
                      –41
                      –17

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      48
                      14

                      4160
                      Budget authority, net (mandatory)
                      4
                      2
                      –9

                      4170
                      Outlays, net (mandatory)
                      –31
                      19
                      –8

                      4180
                      Budget authority, net (total)
                      4
                      2
                      –9

                      4190
                      Outlays, net (total)
                      –31
                      19
                      –8

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      343
                      451
                      475

                      1231
                      Disbursements: Direct loan disbursements
                      115
                      31

                      1251
                      Repayments: Repayments and prepayments
                      –7
                      –7
                      –14

                      1290
                      Outstanding, end of year
                      451
                      475
                      461

          Balance Sheet (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2015 actual
                      2016 actual

                      ASSETS:

                      1101
                      Federal assets: Fund balances with Treasury
                      44
                      124

                      1206
                      Non-Federal assets: Receivables, net
                      16
                      17

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      343
                      451

                      1402
                      Interest receivable
                      1
                      2

                      1405
                      Allowance for subsidy cost (-)
                      –153
                      –281

                      1499
                      Net present value of assets related to direct loans
                      191
                      172

                      1999
                      Total assets
                      251
                      313

                      LIABILITIES:

                      2104
                      Federal liabilities: Resources payable to Treasury
                      244
                      293

                      2207
                      Non-Federal liabilities: Other
                      7
                      20

                      2999
                      Total liabilities
                      251
                      313

                      4999
                      Total liabilities and net position
                      251
                      313

          Trust Funds
             Federal Hospital Insurance Trust Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      161,965
                      158,585
                      166,974

                      0198
                      Unavailable unobligated balance adjustment
                      45

                      0199
                      Balance, start of year
                      162,010
                      158,585
                      166,974

                      Receipts:

                      Current law:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      229,769
                      239,894
                      250,094

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      625
                      570
                      595

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      16,418
                      17,732
                      19,606

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      788
                      775
                      815

                      1130
                      FHI Trust Fund, Other Proprietary Interest from the Public
                      2
                      2
                      2

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      364
                      161
                      175

                      1130
                      FHI Trust Fund, Medicare Refunds
                      8,273
                      6,550
                      6,600

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      11
                      12
                      9

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,232
                      3,520
                      3,713

                      1140
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,625
                      3,734
                      3,806

                      1140
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      660
                      683
                      700

                      1140
                      FHI Trust Fund, Interest Received by Trust Funds
                      8,011
                      7,383
                      7,770

                      1140
                      FHI Trust Fund, Taxation on OASDI Benefits
                      23,022
                      24,210
                      27,425

                      1140
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      130
                      131
                      144

                      1140
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      24
                      590
                      630

                      1140
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      60
                      36
                      36

                      1140
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      54
                      30
                      31

                      1140
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      32
                      28
                      30

                      1140
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      279
                      1,149
                      1,323

                      1199
                      Total current law receipts
                      295,379
                      307,190
                      323,504

                      1999
                      Total receipts
                      295,379
                      307,190
                      323,504

                      2000
                      Total: Balances and receipts
                      457,389
                      465,775
                      490,478

                      Appropriations:

                      Current law:

                      2101
                      Federal Hospital Insurance Trust Fund
                      –2,278
                      –2,362
                      –2,204

                      2101
                      Federal Hospital Insurance Trust Fund
                      –291,219
                      –303,011
                      –319,072

                      2101
                      Health Care Fraud and Abuse Control Account
                      –681
                      –681
                      –751

                      2101
                      Health Care Fraud and Abuse Control Account
                      –1,329
                      –1,293
                      –1,062

                      2103
                      Federal Hospital Insurance Trust Fund
                      –3,354

                      2132
                      Federal Hospital Insurance Trust Fund
                      7

                      2132
                      Health Care Fraud and Abuse Control Account
                      50
                      50

                      2134
                      Federal Hospital Insurance Trust Fund

                      8,496
                      19,644

                      2199
                      Total current law appropriations
                      –298,804
                      –298,801
                      –303,445

                      Proposed:

                      2201
                      Federal Hospital Insurance Trust Fund

                      –79

                      2203
                      Federal Hospital Insurance Trust Fund

                      26

                      2299
                      Total proposed appropriations

                      –53

                      2999
                      Total appropriations
                      –298,804
                      –298,801
                      –303,498

                      5099
                      Balance, end of year
                      158,585
                      166,974
                      186,980

          Program and Financing (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI
                      291,248
                      293,284
                      298,434

                      0002
                      HIT Incentive Payments
                      1,845
                      459
                      15

                      0003
                      Administration, HI
                      3,308
                      2,680
                      2,538

                      0004
                      Quality improvement organizations, HI
                      447
                      445
                      645

                      0799
                      Total direct obligations
                      296,848
                      296,868
                      301,632

                      0900
                      Total new obligations, unexpired accounts
                      296,848
                      296,868
                      301,632

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      4

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      2,278
                      2,362
                      2,204

                      1130
                      Appropriations permanently reduced

                      –9

                      1160
                      Appropriation, discretionary (total)
                      2,278
                      2,353
                      2,204

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      291,219
                      303,011
                      319,072

                      1203
                      Appropriation (previously unavailable)
                      3,354

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                      –7

                      1234
                      Appropriations precluded from obligation

                      –8,496
                      –19,644

                      1260
                      Appropriations, mandatory (total)
                      294,566
                      294,515
                      299,428

                      1900
                      Budget authority (total)
                      296,844
                      296,868
                      301,632

                      1930
                      Total budgetary resources available
                      296,848
                      296,868
                      301,632

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      32,217
                      31,859
                      30,951

                      3010
                      New obligations, unexpired accounts
                      296,848
                      296,868
                      301,632

                      3020
                      Outlays (gross)
                      –297,204
                      –297,776
                      –302,481

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3050
                      Unpaid obligations, end of year
                      31,859
                      30,951
                      30,102

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      32,217
                      31,859
                      30,951

                      3200
                      Obligated balance, end of year
                      31,859
                      30,951
                      30,102

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,278
                      2,353
                      2,204

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,506
                      2,201
                      2,055

                      4011
                      Outlays from discretionary balances
                      1,222
                      961
                      889

                      4020
                      Outlays, gross (total)
                      2,728
                      3,162
                      2,944

                      Mandatory:

                      4090
                      Budget authority, gross
                      294,566
                      294,515
                      299,428

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      265,163
                      265,375
                      268,957

                      4101
                      Outlays from mandatory balances
                      29,313
                      29,239
                      30,580

                      4110
                      Outlays, gross (total)
                      294,476
                      294,614
                      299,537

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4160
                      Budget authority, net (mandatory)
                      294,566
                      294,515
                      299,428

                      4170
                      Outlays, net (mandatory)
                      294,474
                      294,614
                      299,537

                      4180
                      Budget authority, net (total)
                      296,844
                      296,868
                      301,632

                      4190
                      Outlays, net (total)
                      297,202
                      297,776
                      302,481

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      195,458
                      192,209
                      198,402

                      5001
                      Total investments, EOY: Federal securities: Par value
                      192,209
                      198,402
                      217,915

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      296,844
                      296,868
                      301,632

                      Outlays
                      297,202
                      297,776
                      302,481

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      53

                      Outlays

                      43

                      Total:

                      Budget Authority
                      296,844
                      296,868
                      301,685

                      Outlays
                      297,202
                      297,776
                      302,524

             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 repeals the Independent Payment Advisory Board and has other
                indirect effects on Medicare spending.

          Status of Funds (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      196,064
                      192,518
                      199,159

                      0999
                      Total balance, start of year
                      196,064
                      192,518
                      199,159

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      229,769
                      239,894
                      250,094

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      625
                      570
                      595

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      16,418
                      17,732
                      19,606

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      788
                      775
                      815

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      364
                      161
                      175

                      1130
                      FHI Trust Fund, Medicare Refunds
                      8,273
                      6,550
                      6,600

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      11
                      12
                      9

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,232
                      3,520
                      3,713

                      1130
                      Federal Hospital Insurance Trust Fund
                      2

                      1130
                      Health Care Fraud and Abuse Control Account
                      2

                      1150
                      FHI Trust Fund, Interest Received by Trust Funds
                      8,011
                      7,383
                      7,770

                      1150
                      FHI Trust Fund, Other Proprietary Interest from the Public
                      2
                      2
                      2

                      1150
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      32
                      28
                      30

                      1160
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,625
                      3,734
                      3,806

                      1160
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      660
                      683
                      700

                      1160
                      FHI Trust Fund, Taxation on OASDI Benefits
                      23,022
                      24,210
                      27,425

                      1160
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      130
                      131
                      144

                      1160
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      24
                      590
                      630

                      1160
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      60
                      36
                      36

                      1160
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      54
                      30
                      31

                      1160
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      279
                      1,149
                      1,323

                      1199
                      Income under present law
                      295,383
                      307,190
                      323,504

                      Proposed:

                      Offsetting receipts (proprietary):

                      1230
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible

                      1250
                      FHI Trust Fund, Interest Received by Trust Funds

                      1299
                      Income proposed

                      1999
                      Total cash income
                      295,383
                      307,190
                      323,504

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Hospital Insurance Trust Fund [009–38–8005–0]
                      –297,204
                      –297,776
                      –302,481

                      2100
                      Health Care Fraud and Abuse Control Account [009–38–8393–0]
                      –1,727
                      –2,764
                      –1,988

                      2199
                      Outgo under current law
                      –298,931
                      –300,540
                      –304,469

                      Proposed:

                      2200
                      Federal Hospital Insurance Trust Fund

                      –43

                      2299
                      Outgo under proposed legislation

                      –43

                      2999
                      Total cash outgo (-)
                      –298,931
                      –300,540
                      –304,512

                      Surplus or deficit::

                      3110
                      Excluding interest
                      –11,593
                      –763
                      11,190

                      3120
                      Interest
                      8,045
                      7,413
                      7,802

                      3199
                      Subtotal, surplus or deficit
                      –3,548
                      6,650
                      18,992

                      3220
                      Federal Hospital Insurance Trust Fund

                      –9

                      3298
                      Rounding adjustment
                      2

                      3299
                      Total adjustments
                      2
                      –9

                      3999
                      Total change in fund balance
                      –3,546
                      6,641
                      18,992

                      Unexpended balance, end of year::

                      4100
                      Uninvested balance (net), end of year
                      309
                      757
                      236

                      4200
                      Federal Hospital Insurance Trust Fund
                      192,209
                      198,402
                      217,915

                      4999
                      Total balance, end of year
                      192,518
                      199,159
                      218,151

          Object Classification (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      41.0
                      Payment for Quality Improvement Organization (QIO) activities
                      447
                      445
                      645

                      42.0
                      Insurance claims and indemnities (benefits)
                      293,093
                      293,743
                      298,449

                      94.0
                      Financial transfers
                      3,308
                      2,680
                      2,538

                      99.9
                      Total new obligations, unexpired accounts
                      296,848
                      296,868
                      301,632

          Employment Summary

                      Identification code 075–8005–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      2
                      2

             Federal Hospital Insurance Trust Fund

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8005–4–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI

                      –16

                      0003
                      Administration, HI

                      61

                      0799
                      Total direct obligations

                      45

                      0900
                      Total new obligations, unexpired accounts

                      45

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      79

                      1203
                      Appropriation (previously unavailable)

                      –26

                      1260
                      Appropriations, mandatory (total)

                      53

                      1900
                      Budget authority (total)

                      53

                      1930
                      Total budgetary resources available

                      53

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      8

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      45

                      3020
                      Outlays (gross)

                      –43

                      3050
                      Unpaid obligations, end of year

                      2

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      53

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      43

                      4180
                      Budget authority, net (total)

                      53

                      4190
                      Outlays, net (total)

                      43

          Object Classification (in millions of dollars)

                      Identification code 075–8005–4–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities (benefits)

                      –16

                      94.0
                      Financial transfers

                      61

                      99.9
                      Total new obligations, unexpired accounts

                      45

             health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management, $751,000,000, to remain available through September 30, 2019, 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 $610,391,000 shall be for the Centers for Medicare  and Medicaid Services program integrity activities, of which $74,246,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities
                authorized by section 1817(k)(3) of such Act, and of which $66,363,000 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 2018 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 $434,000,000 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 Senior Medicare Patrol program to combat health care fraud and abuse from the funds provided to this account.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–8393–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Medicare integrity program
                      843
                      859
                      899

                      0002
                      FBI fraud and abuse control
                      130
                      131
                      144

                      0003
                      Other fraud and abuse control
                      283
                      280
                      307

                      0005
                      Undistributed Savings, HCFAC and SSA

                      –27
                      –290

                      0091
                      Total Mandatory
                      1,256
                      1,243
                      1,060

                      0101
                      CMS discretionary
                      488
                      553
                      610

                      0102
                      Other discretionary
                      128
                      128
                      141

                      0191
                      Total Discretionary
                      616
                      681
                      751

                      0900
                      Total new obligations, unexpired accounts
                      1,872
                      1,924
                      1,811

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      321
                      406
                      406

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      188
                      248

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      324
                      406
                      406

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      681
                      681
                      751

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      1,329
                      1,293
                      1,062

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –50
                      –50

                      1260
                      Appropriations, mandatory (total)
                      1,279
                      1,243
                      1,062

                      1900
                      Budget authority (total)
                      1,960
                      1,924
                      1,813

                      1930
                      Total budgetary resources available
                      2,284
                      2,330
                      2,219

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –6

                      1941
                      Unexpired unobligated balance, end of year
                      406
                      406
                      408

                      Special and non-revolving trust funds:

                      1951
                      Unobligated balance expiring
                      6

                      1952
                      Expired unobligated balance, start of year
                      33
                      23
                      23

                      1953
                      Expired unobligated balance, end of year
                      17
                      23
                      23

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,498
                      1,617
                      777

                      3010
                      New obligations, unexpired accounts
                      1,872
                      1,924
                      1,811

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      2

                      3020
                      Outlays (gross)
                      –1,727
                      –2,764
                      –1,988

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –25

                      3050
                      Unpaid obligations, end of year
                      1,617
                      777
                      600

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,498
                      1,617
                      777

                      3200
                      Obligated balance, end of year
                      1,617
                      777
                      600

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      681
                      681
                      751

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      67
                      681
                      751

                      4011
                      Outlays from discretionary balances
                      435
                      248

                      4020
                      Outlays, gross (total)
                      502
                      929
                      751

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4052
                      Offsetting collections credited to expired accounts
                      2

                      4070
                      Budget authority, net (discretionary)
                      681
                      681
                      751

                      4080
                      Outlays, net (discretionary)
                      500
                      929
                      751

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,279
                      1,243
                      1,062

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      546
                      879
                      638

                      4101
                      Outlays from mandatory balances
                      679
                      956
                      599

                      4110
                      Outlays, gross (total)
                      1,225
                      1,835
                      1,237

                      4180
                      Budget authority, net (total)
                      1,960
                      1,924
                      1,813

                      4190
                      Outlays, net (total)
                      1,725
                      2,764
                      1,988

             The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse
                Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
                HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
                (HHS), the Department of Justice, and other agencies.

             The Budget includes a discretionary request for efforts to safeguard 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 075–8393–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent (CMS)
                      47
                      78
                      78

                      12.1
                      Civilian personnel benefits (CMS)
                      13
                      21
                      21

                      23.3
                      Communications, utilities, and miscellaneous charges
                      13
                      21
                      21

                      25.2
                      Other services (CMS/Medicaid)
                      75
                      55
                      62

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/DOJ)
                      119
                      119
                      130

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OIG)
                      255
                      259
                      284

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OGC)
                      8
                      7
                      8

                      25.3
                      Other goods and services from Federal sources (HHS/CMS)
                      9
                      5
                      5

                      25.3
                      Other goods and services from Government accounts (HHS/FDA)
                      4
                      4
                      4

                      25.6
                      Medical care  (CMS)
                      1,199
                      1,251
                      1,344

                      92.0
                      Undistributed

                      –27
                      –290

                      94.0
                      Financial transfers (FBI)
                      130
                      131
                      144

                      99.9
                      Total new obligations, unexpired accounts
                      1,872
                      1,924
                      1,811

          Employment Summary

                      Identification code 075–8393–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      506
                      525
                      525

             Federal Supplementary Medical Insurance Trust Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year
                      39,267
                      39,603
                      44,064

                      0198
                      Unavailable unobligated balance adjustment
                      53

                      0199
                      Balance, start of year
                      39,320
                      39,603
                      44,064

                      Receipts:

                      Current law:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      2,853
                      4,067
                      4,098

                      1130
                      Other Proprietary Interest from the Public, FSMI Fund
                      10
                      3
                      3

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      4,514
                      5,006
                      5,689

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      9,755
                      11,029
                      11,875

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      422
                      189
                      210

                      1130
                      Medicare Refunds, SMI
                      5,084
                      5,150
                      5,200

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      8
                      8
                      8

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      60,630
                      67,400
                      78,657

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      11,835
                      11,806
                      12,787

                      1140
                      Federal Contributions, FSMI Fund
                      219,761
                      229,782
                      245,396

                      1140
                      Interest Received by Trust Fund, FSMI Fund
                      1,992
                      1,520
                      1,029

                      1140
                      Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI

                      3
                      3

                      1140
                      Interest, Medicare Prescription Drug Account, FSMI
                      28
                      18
                      15

                      1140
                      Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                      434
                      716
                      659

                      1140
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      76,007
                      78,433
                      76,133

                      1140
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Total current law receipts
                      393,335
                      415,131
                      441,763

                      Proposed:

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –21

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –3

                      1240
                      Federal Contributions, FSMI Fund

                      –72

                      1299
                      Total proposed receipts

                      –96

                      1999
                      Total receipts
                      393,335
                      415,131
                      441,667

                      2000
                      Total: Balances and receipts
                      432,655
                      454,734
                      485,731

                      Appropriations:

                      Current law:

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –2,959
                      –3,085
                      –2,881

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –300,593
                      –316,225
                      –352,198

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –687
                      –699
                      –644

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –89,106
                      –95,128
                      –86,013

                      2134
                      Federal Supplementary Medical Insurance Trust Fund
                      283
                      4,467
                      27,519

                      2199
                      Total current law appropriations
                      –393,062
                      –410,670
                      –414,217

                      Proposed:

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      72

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      –42

                      2203
                      Federal Supplementary Medical Insurance Trust Fund

                      –72

                      2234
                      Federal Supplementary Medical Insurance Trust Fund

                      58

                      2299
                      Total proposed appropriations

                      16

                      2999
                      Total appropriations
                      –393,062
                      –410,670
                      –414,201

                      5098
                      Unavailable unobligated balance adjustment
                      10

                      5099
                      Balance, end of year
                      39,603
                      44,064
                      71,530

          Program and Financing (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI
                      300,922
                      310,022
                      323,265

                      0002
                      Transfer to Medicaid for payment of SMI premiums
                      767
                      941
                      1,026

                      0003
                      HIT Incentive Payments
                      930
                      460

                      0004
                      Administration, SMI
                      3,826
                      3,300
                      3,111

                      0005
                      Quality Improvement Organizations, SMI
                      117
                      111
                      161

                      0799
                      Total direct obligations
                      306,562
                      314,834
                      327,563

                      0900
                      Total new obligations, unexpired accounts
                      306,562
                      314,834
                      327,563

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1033
                      Recoveries of prior year paid obligations
                      4

                      1050
                      Unobligated balance (total)
                      5

                      3

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      2,959
                      3,085
                      2,881

                      1130
                      Appropriations permanently reduced

                      –6

                      1160
                      Appropriation, discretionary (total)
                      2,959
                      3,079
                      2,881

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      300,593
                      316,225
                      352,198

                      1234
                      Appropriations precluded from obligation
                      –283
                      –4,467
                      –27,519

                      1236
                      Appropriations applied to repay debt
                      –432

                      1260
                      Appropriations, mandatory (total)
                      299,878
                      311,758
                      324,679

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      3,720

                      1900
                      Budget authority (total)
                      306,557
                      314,837
                      327,560

                      1930
                      Total budgetary resources available
                      306,562
                      314,837
                      327,563

                      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
                      23,289
                      25,829
                      26,270

                      3010
                      New obligations, unexpired accounts
                      306,562
                      314,834
                      327,563

                      3020
                      Outlays (gross)
                      –304,021
                      –314,393
                      –327,176

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      25,829
                      26,270
                      26,657

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –11,172

                      3061
                      Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                      11,172

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      23,289
                      25,829
                      26,270

                      3200
                      Obligated balance, end of year
                      25,829
                      26,270
                      26,657

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,959
                      3,079
                      2,881

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,291
                      1,886
                      1,785

                      4011
                      Outlays from discretionary balances
                      1,224
                      704
                      658

                      4020
                      Outlays, gross (total)
                      2,515
                      2,590
                      2,443

                      Mandatory:

                      4090
                      Budget authority, gross
                      303,598
                      311,758
                      324,679

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      280,159
                      288,117
                      296,521

                      4101
                      Outlays from mandatory balances
                      21,347
                      23,686
                      28,212

                      4110
                      Outlays, gross (total)
                      301,506
                      311,803
                      324,733

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –4

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      4

                      4160
                      Budget authority, net (mandatory)
                      303,598
                      311,758
                      324,679

                      4170
                      Outlays, net (mandatory)
                      301,502
                      311,803
                      324,733

                      4180
                      Budget authority, net (total)
                      306,557
                      314,837
                      327,560

                      4190
                      Outlays, net (total)
                      304,017
                      314,393
                      327,176

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      66,128
                      63,336
                      66,361

                      5001
                      Total investments, EOY: Federal securities: Par value
                      63,336
                      66,361
                      93,481

                      5080
                      Outstanding debt, SOY

                      –3,288
                      –3,288

                      5081
                      Outstanding debt, EOY
                      –3,288
                      –3,288
                      –3,288

                      5082
                      Borrowing
                      –3,720

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      306,557
                      314,837
                      327,560

                      Outlays
                      304,017
                      314,393
                      327,176

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –16

                      Outlays

                      –26

                      Total:

                      Budget Authority
                      306,557
                      314,837
                      327,544

                      Outlays
                      304,017
                      314,393
                      327,150

             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. In addition,
                the Budget includes a package of proposals that repeals the Independent Payment Advisory Board and has other indirect effects
                on Medicare spending.

          Status of Funds (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      69,122
                      62,774
                      67,931

                      0999
                      Total balance, start of year
                      69,122
                      62,774
                      67,931

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      2,853
                      4,067
                      4,098

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      4,514
                      5,006
                      5,689

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      9,755
                      11,029
                      11,875

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      422
                      189
                      210

                      1130
                      Medicare Refunds, SMI
                      5,084
                      5,150
                      5,200

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      8
                      8
                      8

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      60,630
                      67,400
                      78,657

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      11,835
                      11,806
                      12,787

                      1130
                      Federal Supplementary Medical Insurance Trust Fund
                      4

                      1130
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      39

                      1150
                      Interest Received by Trust Fund, FSMI Fund
                      1,992
                      1,520
                      1,029

                      1150
                      Other Proprietary Interest from the Public, FSMI Fund
                      10
                      3
                      3

                      1150
                      Interest, Medicare Prescription Drug Account, FSMI
                      28
                      18
                      15

                      1160
                      Federal Contributions, FSMI Fund
                      219,761
                      229,782
                      245,396

                      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
                      434
                      716
                      659

                      1160
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      76,007
                      78,433
                      76,133

                      1160
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Income under present law
                      393,378
                      415,131
                      441,763

                      Proposed:

                      Offsetting receipts (proprietary):

                      1230
                      Premiums Collected for Medicare Prescription Drug Account, FSMI

                      1230
                      Payments from States, Medicare Prescription Drug Account, FSMI

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –21

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –3

                      Offsetting governmental receipts:

                      1260
                      Federal Contributions, FSMI Fund

                      –72

                      1260
                      Federal Contributions for Benefits, Prescription Drug Account, SMI

                      1299
                      Income proposed

                      –96

                      1999
                      Total cash income
                      393,378
                      415,131
                      441,667

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]
                      –304,021
                      –314,393
                      –327,176

                      2100
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]
                      –95,705
                      –95,575
                      –86,432

                      2199
                      Outgo under current law
                      –399,726
                      –409,968
                      –413,608

                      Proposed:

                      2200
                      Federal Supplementary Medical Insurance Trust Fund

                      26

                      2299
                      Outgo under proposed legislation

                      26

                      2999
                      Total cash outgo (-)
                      –399,726
                      –409,968
                      –413,582

                      Surplus or deficit::

                      3110
                      Excluding interest
                      –8,378
                      3,622
                      27,038

                      3120
                      Interest
                      2,030
                      1,541
                      1,047

                      3199
                      Subtotal, surplus or deficit
                      –6,348
                      5,163
                      28,085

                      3220
                      Federal Supplementary Medical Insurance Trust Fund

                      –6

                      3299
                      Total adjustments

                      –6

                      3999
                      Total change in fund balance
                      –6,348
                      5,157
                      28,085

                      Unexpended balance, end of year::

                      4100
                      Uninvested balance (net), end of year
                      –562
                      1,570
                      2,535

                      4200
                      Federal Supplementary Medical Insurance Trust Fund
                      63,336
                      66,361
                      93,481

                      4999
                      Total balance, end of year
                      62,774
                      67,931
                      96,016

          Object Classification (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1
                      1

                      41.0
                      Payment for Quality Improvement Organization (QIO) activity
                      117
                      111
                      161

                      42.0
                      Insurance claims and indemnities
                      303,486
                      311,422
                      324,290

                      94.0
                      Financial transfers
                      2,959
                      3,300
                      3,111

                      99.0
                      Direct obligations
                      306,562
                      314,834
                      327,563

                      99.9
                      Total new obligations, unexpired accounts
                      306,562
                      314,834
                      327,563

          Employment Summary

                      Identification code 075–8004–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      5
                      5

             Federal Supplementary Medical Insurance Trust Fund

             (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8004–2–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –72

                      1203
                      Appropriation (previously unavailable)

                      72

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Federal Supplementary Medical Insurance Trust Fund

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–8004–4–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI

                      –96

                      0004
                      Administration, SMI

                      80

                      0900
                      Total new obligations, unexpired accounts

                      –16

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      42

                      1234
                      Appropriations precluded from obligation

                      –58

                      1260
                      Appropriations, mandatory (total)

                      –16

                      1900
                      Budget authority (total)

                      –16

                      1930
                      Total budgetary resources available

                      –16

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –16

                      3020
                      Outlays (gross)

                      26

                      3050
                      Unpaid obligations, end of year

                      10

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      10

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –16

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –26

                      4180
                      Budget authority, net (total)

                      –16

                      4190
                      Outlays, net (total)

                      –26

          Object Classification (in millions of dollars)

                      Identification code 075–8004–4–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities

                      –96

                      94.0
                      Financial transfers

                      80

                      99.0
                      Direct obligations

                      –16

                      99.9
                      Total new obligations, unexpired accounts

                      –16

             Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Prescription Drug Benefits
                      89,102
                      95,108
                      85,996

                      0002
                      Administrative Costs
                      690
                      716
                      659

                      0799
                      Total direct obligations
                      89,792
                      95,824
                      86,655

                      0801
                      Reimbursable program activity
                      2,937

                      0900
                      Total new obligations, unexpired accounts
                      92,729
                      95,824
                      86,655

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      3

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      687
                      699
                      644

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      89,106
                      95,128
                      86,013

                      Spending authority from offsetting collections, mandatory:

                      1801
                      Change in uncollected payments, Federal sources
                      2,937

                      1900
                      Budget authority (total)
                      92,730
                      95,827
                      86,657

                      1930
                      Total budgetary resources available
                      92,730
                      95,827
                      86,660

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year

                      3
                      5

                      Special and non-revolving trust funds:

                      1951
                      Unobligated balance expiring
                      1

                      1952
                      Expired unobligated balance, start of year
                      132
                      40
                      40

                      1953
                      Expired unobligated balance, end of year
                      39
                      40
                      40

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      17,553
                      14,638
                      14,887

                      3010
                      New obligations, unexpired accounts
                      92,729
                      95,824
                      86,655

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      75

                      3020
                      Outlays (gross)
                      –95,705
                      –95,575
                      –86,432

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –14

                      3050
                      Unpaid obligations, end of year
                      14,638
                      14,887
                      15,110

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1

                      –14,109
                      –14,109

                      3061
                      Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                      –11,172

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,937

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –14,109
                      –14,109
                      –14,109

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      6,381
                      529
                      778

                      3200
                      Obligated balance, end of year
                      529
                      778
                      1,001

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      687
                      699
                      644

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      303
                      281
                      264

                      4011
                      Outlays from discretionary balances
                      167
                      123
                      112

                      4020
                      Outlays, gross (total)
                      470
                      404
                      376

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources
                      –39

                      Additional offsets against gross budget authority only:

                      4052
                      Offsetting collections credited to expired accounts
                      39

                      4070
                      Budget authority, net (discretionary)
                      687
                      699
                      644

                      4080
                      Outlays, net (discretionary)
                      431
                      404
                      376

                      Mandatory:

                      4090
                      Budget authority, gross
                      92,043
                      95,128
                      86,013

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      77,667
                      81,350
                      76,801

                      4101
                      Outlays from mandatory balances
                      17,568
                      13,821
                      9,255

                      4110
                      Outlays, gross (total)
                      95,235
                      95,171
                      86,056

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,937

                      4180
                      Budget authority, net (total)
                      89,793
                      95,827
                      86,657

                      4190
                      Outlays, net (total)
                      95,666
                      95,575
                      86,432

             Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
                benefit. The Budget includes a proposal to repeal the Independent Payment Advisory Board, which impacts Medicare Part D.

          Object Classification (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.2
                      Other services from non-Federal sources
                      690
                      716
                      659

                      42.0
                      Insurance claims and indemnities
                      89,102
                      95,108
                      85,996

                      99.0
                      Direct obligations
                      89,792
                      95,824
                      86,655

                      99.0
                      Reimbursable obligations
                      2,937

                      99.9
                      Total new obligations, unexpired accounts
                      92,729
                      95,824
                      86,655

          Employment Summary

                      Identification code 075–8308–0–7–571
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      4
                      4

             Administration for Children and Families

             Federal Funds
             Temporary Assistance for Needy Families

             Program and Financing (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant
                      16,488
                      16,486
                      16,486

                      0002
                      Territories - family assistance grants
                      78
                      78
                      78

                      0006
                      Tribal work programs
                      8
                      8
                      8

                      0009
                      Healthy marriage and responsible fatherhood grants
                      148
                      148
                      150

                      0900
                      Total new obligations, unexpired accounts
                      16,722
                      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
                      –2
                      –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
                      –15
                      –15
                      –15

                      1941
                      Unexpired unobligated balance, end of year

                      2
                      4

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      5,940
                      7,037
                      7,253

                      3010
                      New obligations, unexpired accounts
                      16,722
                      16,720
                      16,722

                      3020
                      Outlays (gross)
                      –15,624
                      –16,504
                      –16,628

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      7,037
                      7,253
                      7,347

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      5,940
                      7,037
                      7,253

                      3200
                      Obligated balance, end of year
                      7,037
                      7,253
                      7,347

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      16,737
                      16,737
                      16,739

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11,962
                      12,540
                      12,542

                      4101
                      Outlays from mandatory balances
                      3,662
                      3,964
                      4,086

                      4110
                      Outlays, gross (total)
                      15,624
                      16,504
                      16,628

                      4180
                      Budget authority, net (total)
                      16,737
                      16,737
                      16,739

                      4190
                      Outlays, net (total)
                      15,624
                      16,504
                      16,628

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      16,737
                      16,737
                      16,739

                      Outlays
                      15,624
                      16,504
                      16,628

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,268

                      Outlays

                      –1,243

                      Total:

                      Budget Authority
                      16,737
                      16,737
                      15,471

                      Outlays
                      15,624
                      16,504
                      15,385

             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. 104–193), as amended by the Deficit Reduction
                Act of 2005 (P.L. 109–171). Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently
                in the Further Continuing and Security Assistance Appropriations Act, 2017 (P.L. 114–254). The Budget proposes to allocate
                funding for Welfare Research and the Census Bureau's Survey of Income and Program Participation from the amount provided for
                TANF Family Assistance Grants, and to reduce the authorized funding for these grants, resulting in a 10 percent reduction
                in the TANF Family Assistance Grants to States, territories, and tribes.

          Object Classification (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1
                      1

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      31
                      29
                      31

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      16,687
                      16,687
                      16,687

                      99.9
                      Total new obligations, unexpired accounts
                      16,722
                      16,720
                      16,722

          Employment Summary

                      Identification code 075–1552–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      13
                      13
                      13

             Temporary Assistance for Needy Families

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1552–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant

                      –1,262

                      0002
                      Territories - family assistance grants

                      –6

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      –1,268

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,243

                      1220
                      Appropriations transferred to other acct [013–0401]

                      –10

                      1220
                      Appropriations transferred to other acct [075–1553]

                      –15

                      1260
                      Appropriations, mandatory (total)

                      –1,268

                      1930
                      Total budgetary resources available

                      –1,268

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,268

                      3020
                      Outlays (gross)

                      1,243

                      3050
                      Unpaid obligations, end of year

                      –25

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –25

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,268

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,243

                      4180
                      Budget authority, net (total)

                      –1,268

                      4190
                      Outlays, net (total)

                      –1,243

             Contingency Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–1522–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Contingency Fund for State Welfare Programs
                      583
                      583
                      608

                      0900
                      Total new obligations (object class 41.0)
                      583
                      583
                      608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1120
                      Appropriations transferred to other acct [075–1553]

                      –15

                      1120
                      Appropriations transferred to other acct [013–0401]

                      –10

                      1160
                      Appropriation, discretionary (total)

                      –25

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      608
                      608
                      608

                      1220
                      Appropriations transferred to other accts [075–1553]
                      –15

                      1220
                      Appropriations transferred to other accts [013–0401]
                      –10

                      1260
                      Appropriations, mandatory (total)
                      583
                      608
                      608

                      1900
                      Budget authority (total)
                      583
                      583
                      608

                      1930
                      Total budgetary resources available
                      583
                      583
                      608

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      61
                      72
                      61

                      3010
                      New obligations, unexpired accounts
                      583
                      583
                      608

                      3020
                      Outlays (gross)
                      –572
                      –594
                      –616

                      3050
                      Unpaid obligations, end of year
                      72
                      61
                      53

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      61
                      72
                      61

                      3200
                      Obligated balance, end of year
                      72
                      61
                      53

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –25

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      –22

                      4011
                      Outlays from discretionary balances

                      –2

                      4020
                      Outlays, gross (total)

                      –22
                      –2

                      Mandatory:

                      4090
                      Budget authority, gross
                      583
                      608
                      608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      544
                      567
                      567

                      4101
                      Outlays from mandatory balances
                      28
                      49
                      51

                      4110
                      Outlays, gross (total)
                      572
                      616
                      618

                      4180
                      Budget authority, net (total)
                      583
                      583
                      608

                      4190
                      Outlays, net (total)
                      572
                      594
                      616

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      583
                      583
                      608

                      Outlays
                      572
                      594
                      616

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –608

                      Outlays

                      –567

                      Total:

                      Budget Authority
                      583
                      583

                      Outlays
                      572
                      594
                      49

              The Budget proposes to eliminate funding for the Contingency Fund.

             Contingency Fund

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1522–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Contingency fund

                      –608

                      0900
                      Total new obligations (object class 41.0)

                      –608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –608

                      1930
                      Total budgetary resources available

                      –608

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –608

                      3020
                      Outlays (gross)

                      567

                      3050
                      Unpaid obligations, end of year

                      –41

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –41

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –567

                      4180
                      Budget authority, net (total)

                      –608

                      4190
                      Outlays, net (total)

                      –567

             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. 321–329), $2,995,400,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2019, $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. 321–329), 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1501–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs
                      3,740
                      3,743
                      3,963

                      0002
                      Child support incentive payments
                      568
                      580
                      588

                      0003
                      Access and visitation grants
                      10
                      10
                      10

                      0091
                      Subtotal, child support enforcement
                      4,318
                      4,333
                      4,561

                      0102
                      Payments to territories
                      33
                      33
                      33

                      0103
                      Repatriation
                      1
                      1
                      1

                      0191
                      Subtotal, other payments
                      34
                      34
                      34

                      0799
                      Total direct obligations
                      4,352
                      4,367
                      4,595

                      0801
                      Offset obligations (CSE grants to States)
                      15
                      12
                      13

                      0900
                      Total new obligations, unexpired accounts
                      4,367
                      4,379
                      4,608

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      227
                      200
                      200

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      2,965
                      2,867
                      2,995

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      1,160
                      1,300
                      1,400

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      15
                      12
                      13

                      1900
                      Budget authority (total)
                      4,140
                      4,179
                      4,408

                      1930
                      Total budgetary resources available
                      4,367
                      4,379
                      4,608

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,047
                      1,093
                      994

                      3010
                      New obligations, unexpired accounts
                      4,367
                      4,379
                      4,608

                      3020
                      Outlays (gross)
                      –4,094
                      –4,278
                      –4,425

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –227
                      –200
                      –200

                      3050
                      Unpaid obligations, end of year
                      1,093
                      994
                      977

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,047
                      1,093
                      994

                      3200
                      Obligated balance, end of year
                      1,093
                      994
                      977

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,140
                      4,179
                      4,408

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3,521
                      3,564
                      3,776

                      4101
                      Outlays from mandatory balances
                      573
                      714
                      649

                      4110
                      Outlays, gross (total)
                      4,094
                      4,278
                      4,425

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –15
                      –12
                      –13

                      4180
                      Budget authority, net (total)
                      4,125
                      4,167
                      4,395

                      4190
                      Outlays, net (total)
                      4,079
                      4,266
                      4,412

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      4,125
                      4,167
                      4,395

                      Outlays
                      4,079
                      4,266
                      4,412

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –110

                      Outlays

                      –110

                      Total:

                      Budget Authority
                      4,125
                      4,167
                      4,285

                      Outlays
                      4,079
                      4,266
                      4,302

             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 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 075–1501–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      41.0
                      Direct obligations: Grants, subsidies, and contributions
                      4,352
                      4,367
                      4,595

                      99.0
                      Reimbursable obligations
                      15
                      12
                      13

                      99.9
                      Total new obligations, unexpired accounts
                      4,367
                      4,379
                      4,608

             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 075–1501–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs

                      –110

                      0091
                      Subtotal, child support enforcement

                      –110

                      0799
                      Total direct obligations

                      –110

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      –110

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –110

                      1900
                      Budget authority (total)

                      –110

                      1930
                      Total budgetary resources available

                      –110

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –110

                      3020
                      Outlays (gross)

                      110

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –110

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –110

                      4180
                      Budget authority, net (total)

                      –110

                      4190
                      Outlays, net (total)

                      –110

             Low income home energy assistance
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      LIHEAP Block Grant
                      3,372
                      3,384

                      Budgetary resources:

                      Unobligated balance:

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,390
                      3,384

                      1120
                      Appropriations transferred to other acct [075–0140]
                      –19

                      1160
                      Appropriation, discretionary (total)
                      3,371
                      3,384

                      1930
                      Total budgetary resources available
                      3,372
                      3,384

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,134
                      1,230
                      1,513

                      3010
                      New obligations, unexpired accounts
                      3,372
                      3,384

                      3020
                      Outlays (gross)
                      –3,262
                      –3,101
                      –1,113

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –14

                      3050
                      Unpaid obligations, end of year
                      1,230
                      1,513
                      400

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,134
                      1,230
                      1,513

                      3200
                      Obligated balance, end of year
                      1,230
                      1,513
                      400

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,371
                      3,384

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,293
                      2,132

                      4011
                      Outlays from discretionary balances
                      969
                      969
                      1,113

                      4020
                      Outlays, gross (total)
                      3,262
                      3,101
                      1,113

                      4180
                      Budget authority, net (total)
                      3,371
                      3,384

                      4190
                      Outlays, net (total)
                      3,262
                      3,101
                      1,113

          Object Classification (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      2
                      2

                      41.0
                      Grants, subsidies, and contributions
                      3,370
                      3,382

                      99.9
                      Total new obligations, unexpired accounts
                      3,372
                      3,384

             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, $1,456,755,000 of which $1,427,321,000 shall remain available through September 30, 2020 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 204 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 funds made available under this heading in this and prior Acts shall be available to reimburse other
                   Federal agencies for the costs of making land or facilities available for temporary housing of unaccompanied alien children
                   as defined in section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, if the Secretary
                   determines that such housing is needed for purposes of carrying out such section 235 and section 462 of the Homeland Security
                   Act of 2002: Provided further, That such funds may be used for construction and improvements to property and demolition as
                   necessary for this purpose: Provided further, That other Federal agencies are hereby authorized for the current fiscal year
                   to make land or facilities available for the purposes described in the third proviso, and to retain and use such reimbursements
                   to cover costs incurred.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Refugee and entrant assistance
                      735
                      695
                      479

                      0002
                      Assistance for treatment of torture victims
                      11
                      11
                      11

                      0003
                      Unaccompanied Children
                      1,101
                      1,398
                      948

                      0005
                      Trafficking Victims program
                      18
                      18
                      19

                      0900
                      Total new obligations, unexpired accounts
                      1,865
                      2,122
                      1,457

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      278
                      96
                      96

                      1021
                      Recoveries of prior year unpaid obligations
                      12

                      1050
                      Unobligated balance (total)
                      290
                      96
                      96

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Base Appropriation
                      1,675
                      1,672
                      1,457

                      1100
                      UC Contingency Fund

                      150

                      1121
                      Appropriations transferred from other acct [075–0125]

                      300

                      1160
                      Appropriation, discretionary (total)
                      1,675
                      2,122
                      1,457

                      1930
                      Total budgetary resources available
                      1,965
                      2,218
                      1,553

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –4

                      1941
                      Unexpired unobligated balance, end of year
                      96
                      96
                      96

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      781
                      995
                      741

                      3010
                      New obligations, unexpired accounts
                      1,865
                      2,122
                      1,457

                      3020
                      Outlays (gross)
                      –1,632
                      –2,376
                      –1,451

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –12

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –7

                      3050
                      Unpaid obligations, end of year
                      995
                      741
                      747

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      781
                      995
                      741

                      3200
                      Obligated balance, end of year
                      995
                      741
                      747

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,675
                      2,122
                      1,457

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      906
                      1,464
                      1,005

                      4011
                      Outlays from discretionary balances
                      726
                      912
                      446

                      4020
                      Outlays, gross (total)
                      1,632
                      2,376
                      1,451

                      4180
                      Budget authority, net (total)
                      1,675
                      2,122
                      1,457

                      4190
                      Outlays, net (total)
                      1,632
                      2,376
                      1,451

             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 alien children.

          Object Classification (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      11.1
                      Direct obligations: Personnel compensation: Full-time permanent
                      10
                      11
                      11

                      11.9
                      Total personnel compensation
                      10
                      11
                      11

                      12.1
                      Civilian personnel benefits
                      2
                      4
                      4

                      23.1
                      Rental payments to GSA
                      4
                      4
                      4

                      25.1
                      Advisory and assistance services
                      256
                      227
                      128

                      25.2
                      Other services from non-Federal sources
                      4
                      4
                      4

                      25.3
                      Other goods and services from Federal sources
                      57
                      37
                      21

                      41.0
                      Grants, subsidies, and contributions
                      1,532
                      1,835
                      1,285

                      99.9
                      Total new obligations, unexpired accounts
                      1,865
                      2,122
                      1,457

          Employment Summary

                      Identification code 075–1503–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      95
                      96
                      96

                      1101
                      Direct military average strength employment
                      3
                      4
                      4

             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, $59,651,000.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Grants to States and Tribes
                      343
                      343
                      362

                      0002
                      Research, training and technical assistance
                      8
                      8
                      11

                      0003
                      State court improvement activities
                      30
                      30
                      32

                      0004
                      Family Connection Grants
                      3
                      2
                      1

                      0005
                      Personal Responsibility Education (PREP)
                      76
                      71
                      10

                      0006
                      Abstinence Education
                      67
                      63

                      0900
                      Total new obligations, unexpired accounts
                      527
                      517
                      416

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      25
                      27
                      31

                      1021
                      Recoveries of prior year unpaid obligations
                      5

                      1050
                      Unobligated balance (total)
                      30
                      27
                      31

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      60
                      60
                      60

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      495
                      495
                      345

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –23
                      –34

                      1260
                      Appropriations, mandatory (total)
                      472
                      461
                      345

                      1900
                      Budget authority (total)
                      532
                      521
                      405

                      1930
                      Total budgetary resources available
                      562
                      548
                      436

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –8

                      1941
                      Unexpired unobligated balance, end of year
                      27
                      31
                      20

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      537
                      562
                      533

                      3010
                      New obligations, unexpired accounts
                      527
                      517
                      416

                      3020
                      Outlays (gross)
                      –479
                      –524
                      –509

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –5

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –18
                      –22

                      3050
                      Unpaid obligations, end of year
                      562
                      533
                      440

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      537
                      562
                      533

                      3200
                      Obligated balance, end of year
                      562
                      533
                      440

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      60
                      60
                      60

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      23
                      21
                      21

                      4011
                      Outlays from discretionary balances
                      35
                      38
                      37

                      4020
                      Outlays, gross (total)
                      58
                      59
                      58

                      Mandatory:

                      4090
                      Budget authority, gross
                      472
                      461
                      345

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      113
                      114
                      107

                      4101
                      Outlays from mandatory balances
                      308
                      351
                      344

                      4110
                      Outlays, gross (total)
                      421
                      465
                      451

                      4180
                      Budget authority, net (total)
                      532
                      521
                      405

                      4190
                      Outlays, net (total)
                      479
                      524
                      509

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      532
                      521
                      405

                      Outlays
                      479
                      524
                      509

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      150

                      Outlays

                      3

                      Total:

                      Budget Authority
                      532
                      521
                      555

                      Outlays
                      479
                      524
                      512

             This account provides funds for a broad range of child welfare services, including family preservation and support services
                and grants to increase the well-being of and improve the permanency outcomes for children affected by substance abuse, through
                Promoting Safe and Stable Families. The Budget includes a five-year reauthorization of Promoting Safe and Stable Families,
                and a two-year reauthorization of Abstinence Education and the Personal Responsibility Education Program (PREP).

          Object Classification (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1

                      25.1
                      Advisory and assistance services
                      12
                      10
                      5

                      25.3
                      Other goods and services from Federal sources
                      3
                      4
                      3

                      41.0
                      Grants, subsidies, and contributions
                      511
                      502
                      408

                      99.9
                      Total new obligations, unexpired accounts
                      527
                      517
                      416

          Employment Summary

                      Identification code 075–1512–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      10
                      9
                      2

             Promoting Safe and Stable Families

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1512–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0005
                      PREP

                      75

                      0006
                      Abstinence Education

                      68

                      0900
                      Total new obligations, unexpired accounts

                      143

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      150

                      1930
                      Total budgetary resources available

                      150

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      7

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      143

                      3020
                      Outlays (gross)

                      –3

                      3050
                      Unpaid obligations, end of year

                      140

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      140

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      3

                      4180
                      Budget authority, net (total)

                      150

                      4190
                      Outlays, net (total)

                      3

          Object Classification (in millions of dollars)

                      Identification code 075–1512–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.1
                      Advisory and assistance services

                      5

                      41.0
                      Grants, subsidies, and contributions

                      137

                      99.9
                      Total new obligations, unexpired accounts

                      143

          Employment Summary

                      Identification code 075–1512–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      7

             Child Care Entitlement to States

             Program and Financing (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Mandatory child care
                      1,178
                      1,178
                      1,178

                      0002
                      Matching child care
                      1,697
                      1,662
                      1,662

                      0003
                      Child Care Training and technical assistance
                      14
                      15
                      15

                      0004
                      Child care tribal grants
                      58
                      58
                      58

                      0005
                      Child Care Research
                      4
                      4
                      4

                      0900
                      Total new obligations, unexpired accounts
                      2,951
                      2,917
                      2,917

                      Budgetary resources:

                      Unobligated balance:

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      34

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      2,917
                      2,917
                      2,917

                      1930
                      Total budgetary resources available
                      2,951
                      2,917
                      2,917

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      927
                      1,054
                      1,003

                      3010
                      New obligations, unexpired accounts
                      2,951
                      2,917
                      2,917

                      3020
                      Outlays (gross)
                      –2,788
                      –2,968
                      –2,946

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –36

                      3050
                      Unpaid obligations, end of year
                      1,054
                      1,003
                      974

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      927
                      1,054
                      1,003

                      3200
                      Obligated balance, end of year
                      1,054
                      1,003
                      974

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,917
                      2,917
                      2,917

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2,052
                      2,175
                      2,175

                      4101
                      Outlays from mandatory balances
                      736
                      793
                      771

                      4110
                      Outlays, gross (total)
                      2,788
                      2,968
                      2,946

                      4180
                      Budget authority, net (total)
                      2,917
                      2,917
                      2,917

                      4190
                      Outlays, net (total)
                      2,788
                      2,968
                      2,946

             This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Further Continuing and
                Security Assistance Appropriations Act, 2017 (P.L. 114–254).

          Object Classification (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      7
                      7
                      7

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      2,943
                      2,909
                      2,909

                      99.9
                      Total new obligations, unexpired accounts
                      2,951
                      2,917
                      2,917

             Payments to states for the child care and development block grantFor carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $2,761,000,000 shall be used to supplement, not supplant State general revenue funds for child care assistance
                for low-income families: Provided,  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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Child Care Block grant payments to States
                      2,751
                      2,746
                      2,751

                      0004
                      Child Care Research and evaluation fund
                      10
                      10
                      10

                      0900
                      Total new obligations, unexpired accounts
                      2,761
                      2,756
                      2,761

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,761
                      2,756
                      2,761

                      1930
                      Total budgetary resources available
                      2,761
                      2,756
                      2,761

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      829
                      1,070
                      1,101

                      3010
                      New obligations, unexpired accounts
                      2,761
                      2,756
                      2,761

                      3020
                      Outlays (gross)
                      –2,518
                      –2,725
                      –2,772

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      1,070
                      1,101
                      1,090

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      829
                      1,070
                      1,101

                      3200
                      Obligated balance, end of year
                      1,070
                      1,101
                      1,090

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,761
                      2,756
                      2,761

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,881
                      1,929
                      1,933

                      4011
                      Outlays from discretionary balances
                      637
                      796
                      839

                      4020
                      Outlays, gross (total)
                      2,518
                      2,725
                      2,772

                      4180
                      Budget authority, net (total)
                      2,761
                      2,756
                      2,761

                      4190
                      Outlays, net (total)
                      2,518
                      2,725
                      2,772

             This program provides grants to States for child care subsidies for low-income working families and activities to improve
                child care quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      21
                      21
                      21

                      41.0
                      Grants, subsidies, and contributions
                      2,740
                      2,735
                      2,740

                      99.9
                      Total new obligations, unexpired accounts
                      2,761
                      2,756
                      2,761

             Social services block grant
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Social Services Block Grant
                      1,584
                      1,583
                      1,700

                      0002
                      Health Profession Opportunity Grants
                      85
                      79

                      0900
                      Total new obligations, unexpired accounts
                      1,669
                      1,662
                      1,700

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      30
                      29
                      29

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,785
                      1,785
                      1,700

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –116
                      –123

                      1260
                      Appropriations, mandatory (total)
                      1,669
                      1,662
                      1,700

                      1930
                      Total budgetary resources available
                      1,699
                      1,691
                      1,729

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      29
                      29
                      29

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      592
                      480
                      443

                      3010
                      New obligations, unexpired accounts
                      1,669
                      1,662
                      1,700

                      3020
                      Outlays (gross)
                      –1,780
                      –1,699
                      –1,770

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1

                      3050
                      Unpaid obligations, end of year
                      480
                      443
                      373

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      592
                      480
                      443

                      3200
                      Obligated balance, end of year
                      480
                      443
                      373

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,669
                      1,662
                      1,700

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,372
                      1,318
                      1,411

                      4101
                      Outlays from mandatory balances
                      408
                      381
                      359

                      4110
                      Outlays, gross (total)
                      1,780
                      1,699
                      1,770

                      4180
                      Budget authority, net (total)
                      1,669
                      1,662
                      1,700

                      4190
                      Outlays, net (total)
                      1,780
                      1,699
                      1,770

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      1,669
                      1,662
                      1,700

                      Outlays
                      1,780
                      1,699
                      1,770

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,615

                      Outlays

                      –1,408

                      Total:

                      Budget Authority
                      1,669
                      1,662
                      85

                      Outlays
                      1,780
                      1,699
                      362

             The Budget proposes to reduce the authorized funding level for the Social Services Block Grant to $0. The account also provides
                funding for the Health Profession Opportunity Grants demonstration to provide education and training to Temporary Assistance
                for Needy Families recipients and other low income individuals for health care occupations in high demand. The Budget proposes
                extending the demonstration through FY 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1

                      25.1
                      Advisory and assistance services
                      12
                      11

                      41.0
                      Grants, subsidies, and contributions
                      1,656
                      1,650
                      1,700

                      99.9
                      Total new obligations, unexpired accounts
                      1,669
                      1,662
                      1,700

          Employment Summary

                      Identification code 075–1534–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      7
                      8

             Social Services Block Grant

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1534–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0002
                      Health Profession Opportunity Grants

                      85

                      0003
                      Social Services Block Grant

                      –1,700

                      0900
                      Total new obligations, unexpired accounts

                      –1,615

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,615

                      1900
                      Budget authority (total)

                      –1,615

                      1930
                      Total budgetary resources available

                      –1,615

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,615

                      3020
                      Outlays (gross)

                      1,408

                      3050
                      Unpaid obligations, end of year

                      –207

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –207

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,615

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,408

                      4180
                      Budget authority, net (total)

                      –1,615

                      4190
                      Outlays, net (total)

                      –1,408

          Object Classification (in millions of dollars)

                      Identification code 075–1534–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.1
                      Advisory and assistance services

                      11

                      41.0
                      Grants, subsidies, and contributions

                      –1,627

                      99.9
                      Total new obligations, unexpired accounts

                      –1,615

          Employment Summary

                      Identification code 075–1534–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      8

             Children and families services programsFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Child Abuse Prevention
                and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services Act, the Native American Programs Act
                of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), part
                B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security Act; and 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 Child Care and Development Block Grant Act of 1990, title IV of the Immigration and Nationality Act, and section 501 of the Refugee Education Assistance Act of 1980; $10,204,294,000, of which $37,871,000, to remain available through September 30, 2019, 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, 2018: Provided, That $9,168,095,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $8,508,095,000 shall be available for payments under section 640 of the Head Start Act: Provided further, That in addition to the amounts for such purposes identified in section 640(a)(2)(D) of the Head Start Act, up to $1,500,000 of
                   amounts made available in the previous proviso may be reserved for research and evaluation on hours of programs operations,
                   notwithstanding paragraphs (3) and (4) of section 640(a) of such Act: 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 shall be available through March 31, 2019 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 $1,860,000 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0101
                      Head Start
                      9,119
                      9,151
                      9,168

                      0103
                      Runaway and homeless youth (basic centers)
                      54
                      54
                      54

                      0104
                      Transitional living
                      48
                      48
                      48

                      0106
                      Education grants to reduce sexual abuse of runaway youth
                      17
                      17
                      17

                      0109
                      Child abuse State grants
                      25
                      25
                      25

                      0110
                      Child abuse discretionary activities
                      33
                      33
                      33

                      0111
                      Community-based child abuse prevention
                      40
                      40
                      40

                      0112
                      Child welfare services
                      269
                      267
                      268

                      0113
                      Child welfare training, research, or demonstration projects
                      18
                      18
                      18

                      0114
                      Adoption opportunities
                      39
                      39
                      30

                      0116
                      Adoption and Legal Guardianship Incentives
                      38
                      38
                      38

                      0117
                      Independent living education and training vouchers
                      43
                      43
                      43

                      0124
                      Native American programs
                      50
                      50
                      50

                      0125
                      Social services and income maintenance research
                      6
                      6
                      6

                      0128
                      ACF Federal administration
                      204
                      205
                      205

                      0131
                      Disaster human services case management
                      2
                      2
                      2

                      0191
                      Direct program activities, subtotal
                      10,005
                      10,036
                      10,045

                      0301
                      Community services block grant
                      715
                      714

                      0303
                      Rural community facilities
                      6
                      6

                      0304
                      Community services discretionary (JOLI & CED)
                      30
                      30

                      0306
                      Assets for independence
                      19
                      19

                      0308
                      Domestic violence hotline
                      8
                      8
                      8

                      0309
                      Family violence prevention and services
                      150
                      150
                      151

                      0391
                      Direct program activities, subtotal
                      928
                      927
                      159

                      0400
                      Total, direct program
                      10,933
                      10,963
                      10,204

                      0799
                      Total direct obligations
                      10,933
                      10,963
                      10,204

                      0801
                      Children and Families Services Programs (Reimbursable)
                      14
                      20
                      20

                      0809
                      Reimbursable program activities, subtotal
                      14
                      20
                      20

                      0900
                      Total new obligations, unexpired accounts
                      10,947
                      10,983
                      10,224

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      377
                      427
                      432

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      377
                      427

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      378
                      427
                      432

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      10,984
                      10,963
                      10,204

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      6
                      19
                      24

                      1701
                      Change in uncollected payments, Federal sources
                      5
                      4

                      1750
                      Spending auth from offsetting collections, disc (total)
                      11
                      23
                      24

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1
                      1
                      1

                      1801
                      Change in uncollected payments, Federal sources
                      1
                      1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      2
                      2
                      1

                      1900
                      Budget authority (total)
                      10,997
                      10,988
                      10,229

                      1930
                      Total budgetary resources available
                      11,375
                      11,415
                      10,661

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      427
                      432
                      437

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,114
                      7,620
                      6,939

                      3010
                      New obligations, unexpired accounts
                      10,947
                      10,983
                      10,224

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      27

                      3020
                      Outlays (gross)
                      –10,402
                      –11,664
                      –10,902

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –65

                      3050
                      Unpaid obligations, end of year
                      7,620
                      6,939
                      6,261

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5
                      –9
                      –14

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –6
                      –5

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –9
                      –14
                      –14

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,109
                      7,611
                      6,925

                      3200
                      Obligated balance, end of year
                      7,611
                      6,925
                      6,247

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      10,995
                      10,986
                      10,228

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,138
                      4,629
                      4,312

                      4011
                      Outlays from discretionary balances
                      6,262
                      7,033
                      6,590

                      4020
                      Outlays, gross (total)
                      10,400
                      11,662
                      10,902

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –7
                      –18
                      –18

                      4033
                      Non-Federal sources

                      –2
                      –6

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –7
                      –20
                      –24

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –5
                      –4

                      4052
                      Offsetting collections credited to expired accounts
                      1
                      1

                      4060
                      Additional offsets against budget authority only (total)
                      –4
                      –3

                      4070
                      Budget authority, net (discretionary)
                      10,984
                      10,963
                      10,204

                      4080
                      Outlays, net (discretionary)
                      10,393
                      11,642
                      10,878

                      Mandatory:

                      4090
                      Budget authority, gross
                      2
                      2
                      1

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2
                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –2
                      –1
                      –1

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –1
                      –1

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)

                      –1

                      4170
                      Outlays, net (mandatory)

                      1
                      –1

                      4180
                      Budget authority, net (total)
                      10,984
                      10,963
                      10,204

                      4190
                      Outlays, net (total)
                      10,393
                      11,643
                      10,877

             The request totals $10.2 billion, including almost $9.2 billion for Head Start. This request discontinues funding for the
                Community Services Block Grant, Rural Community Facilities, Community Economic Development, and Assets for Independence.

          Object Classification (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      108
                      112
                      112

                      11.3
                      Other than full-time permanent
                      6
                      5
                      6

                      11.7
                      Military personnel
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      115
                      118
                      119

                      12.1
                      Civilian personnel benefits
                      34
                      36
                      36

                      21.0
                      Travel and transportation of persons
                      4
                      4
                      4

                      23.1
                      Rental payments to GSA
                      16
                      16
                      16

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      2
                      2

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      192
                      196
                      194

                      25.2
                      Other services from non-Federal sources
                      5
                      7
                      7

                      25.3
                      Other goods and services from Federal sources
                      57
                      51
                      49

                      25.4
                      Operation and maintenance of facilities
                      4
                      3
                      3

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      10,502
                      10,528
                      9,772

                      99.0
                      Direct obligations
                      10,933
                      10,963
                      10,204

                      99.0
                      Reimbursable obligations
                      14
                      20
                      20

                      99.9
                      Total new obligations, unexpired accounts
                      10,947
                      10,983
                      10,224

          Employment Summary

                      Identification code 075–1536–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,118
                      1,132
                      1,117

                      1101
                      Direct military average strength employment
                      8
                      9
                      9

                      2001
                      Reimbursable civilian full-time equivalent employment
                      9
                      9

             Children's Research and Technical Assistance

             Program and Financing (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Training and technical assistance
                      10
                      18
                      12

                      0002
                      Federal parent locator service
                      23
                      29
                      25

                      0004
                      Welfare research
                      15
                      15

                      0799
                      Total direct obligations
                      48
                      62
                      37

                      0801
                      Federal Parent Locator Service reimbursable
                      24
                      28
                      27

                      0899
                      Total reimbursable obligations
                      24
                      28
                      27

                      0900
                      Total new obligations, unexpired accounts
                      72
                      90
                      64

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      6
                      13

                      1021
                      Recoveries of prior year unpaid obligations
                      6
                      1
                      1

                      1050
                      Unobligated balance (total)
                      12
                      14
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1121
                      Appropriations transferred from other acct [075–1522]

                      15

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      37
                      37
                      37

                      1200
                      Appropriation [Pop-up]

                      1
                      1

                      1221
                      Appropriations transferred from other acct [075–1522]
                      15

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –3
                      –3

                      1260
                      Appropriations, mandatory (total)
                      49
                      35
                      38

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      24
                      26
                      26

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –1
                      –1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      24
                      26
                      27

                      1900
                      Budget authority (total)
                      73
                      76
                      65

                      1930
                      Total budgetary resources available
                      85
                      90
                      66

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      13

                      2

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      79
                      43
                      52

                      3010
                      New obligations, unexpired accounts
                      72
                      90
                      64

                      3020
                      Outlays (gross)
                      –102
                      –80
                      –74

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –6
                      –1
                      –1

                      3050
                      Unpaid obligations, end of year
                      43
                      52
                      41

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –6
                      –6
                      –6

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –6
                      –6
                      –6

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      73
                      37
                      46

                      3200
                      Obligated balance, end of year
                      37
                      46
                      35

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      15

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      2

                      4011
                      Outlays from discretionary balances
                      11

                      6

                      4020
                      Outlays, gross (total)
                      11
                      2
                      6

                      Mandatory:

                      4090
                      Budget authority, gross
                      73
                      61
                      65

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      44
                      42
                      44

                      4101
                      Outlays from mandatory balances
                      47
                      36
                      24

                      4110
                      Outlays, gross (total)
                      91
                      78
                      68

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –7
                      –7
                      –7

                      4123
                      Non-Federal sources
                      –17
                      –19
                      –19

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –24
                      –26
                      –26

                      4160
                      Budget authority, net (mandatory)
                      49
                      35
                      39

                      4170
                      Outlays, net (mandatory)
                      67
                      52
                      42

                      4180
                      Budget authority, net (total)
                      49
                      50
                      39

                      4190
                      Outlays, net (total)
                      78
                      54
                      48

                      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)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      49
                      50
                      39

                      Outlays
                      78
                      54
                      48

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      15

                      Outlays

                      15

                      Total:

                      Budget Authority
                      49
                      50
                      54

                      Outlays
                      78
                      54
                      63

             This account provides funding for research and technical assistance activities established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                For fiscal years 2010–2014, 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 legislative proposal
                to transfer $15 million to Welfare Research from the TANF Block Grant beginning in FY 2018.

          Object Classification (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      7
                      7
                      7

                      12.1
                      Civilian personnel benefits
                      2
                      2
                      2

                      23.1
                      Rental payments to GSA
                      3
                      4
                      4

                      25.1
                      Advisory and assistance services
                      13
                      13

                      25.2
                      Other services from non-Federal sources
                      13
                      19
                      14

                      25.3
                      Other goods and services from Federal sources
                      5
                      7
                      7

                      25.6
                      Medical care

                      5

                      25.7
                      Operation and maintenance of equipment
                      3
                      4
                      3

                      41.0
                      Grants, subsidies, and contributions
                      2
                      1

                      99.0
                      Direct obligations
                      48
                      62
                      37

                      99.0
                      Reimbursable obligations
                      24
                      28
                      27

                      99.9
                      Total new obligations, unexpired accounts
                      72
                      90
                      64

          Employment Summary

                      Identification code 075–1553–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      68
                      68
                      68

             Children's Research and Technical Assistance

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1553–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0004
                      Welfare research

                      15

                      0799
                      Total direct obligations

                      15

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1221
                      Appropriations transferred from other acct [075–1552]

                      15

                      1900
                      Budget authority (total)

                      15

                      1930
                      Total budgetary resources available

                      15

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      15

                      3020
                      Outlays (gross)

                      –15

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      15

                      4180
                      Budget authority, net (total)

                      15

                      4190
                      Outlays, net (total)

                      15

          Object Classification (in millions of dollars)

                      Identification code 075–1553–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services

                      13

                      25.3
                      Other goods and services from Federal sources

                      1

                      99.0
                      Direct obligations

                      14

                      99.0
                      Reimbursable obligations

                      1

                      99.9
                      Total new obligations, unexpired accounts

                      15

             Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, $6,225,000,000.
          For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year
                2019, $2,700,000,000.
          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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Foster care
                      4,815
                      5,302
                      5,537

                      0002
                      Independent living
                      140
                      140
                      140

                      0004
                      Adoption assistance
                      2,587
                      2,658
                      2,867

                      0005
                      Guardianship
                      120
                      151
                      181

                      0006
                      Technical Assistance and Implementation Services for Tribal Programs
                      3
                      3
                      3

                      0900
                      Total new obligations, unexpired accounts
                      7,665
                      8,254
                      8,728

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      5,367
                      5,956
                      6,228

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –2
                      –2

                      1260
                      Appropriations, mandatory (total)
                      5,365
                      5,954
                      6,228

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      2,300
                      2,300
                      2,500

                      1900
                      Budget authority (total)
                      7,665
                      8,254
                      8,728

                      1930
                      Total budgetary resources available
                      7,665
                      8,254
                      8,728

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,089
                      1,114
                      1,343

                      3010
                      New obligations, unexpired accounts
                      7,665
                      8,254
                      8,728

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      193

                      3020
                      Outlays (gross)
                      –7,700
                      –8,025
                      –8,439

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –133

                      3050
                      Unpaid obligations, end of year
                      1,114
                      1,343
                      1,632

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,089
                      1,114
                      1,343

                      3200
                      Obligated balance, end of year
                      1,114
                      1,343
                      1,632

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      7,665
                      8,254
                      8,728

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6,815
                      7,118
                      7,530

                      4101
                      Outlays from mandatory balances
                      885
                      907
                      909

                      4110
                      Outlays, gross (total)
                      7,700
                      8,025
                      8,439

                      4180
                      Budget authority, net (total)
                      7,665
                      8,254
                      8,728

                      4190
                      Outlays, net (total)
                      7,700
                      8,025
                      8,439

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      7,665
                      8,254
                      8,728

                      Outlays
                      7,700
                      8,025
                      8,439

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      18

                      Outlays

                      18

                      Total:

                      Budget Authority
                      7,665
                      8,254
                      8,746

                      Outlays
                      7,700
                      8,025
                      8,457

             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 Care—The proposed level will support eligible low-income children who must be placed outside the home. An average of 176,500 children
                per month are estimated to be served in FY 2018.

             Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
                An average of 499,600 children per month are estimated to be served in FY 2018.

             Guardianship Assistance Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
                in foster care. An average of 32,300 children per month are estimated to be served in FY 2018.

             The account includes the interaction effects from the proposal to eliminate SSBG funding, which increases costs in FCP due
                to State agencies shifting eligible expenses previously funded by SSBG to FCP.

          Object Classification (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      35
                      34
                      35

                      41.0
                      Grants, subsidies, and contributions
                      7,629
                      8,219
                      8,692

                      99.9
                      Total new obligations, unexpired accounts
                      7,665
                      8,254
                      8,728

          Employment Summary

                      Identification code 075–1545–0–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      3
                      4
                      4

             Payments for Foster Care and Permanency

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–1545–4–1–609
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Foster care

                      5

                      0004
                      Adoption assistance

                      12

                      0005
                      Guardianship

                      1

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)

                      18

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      18

                      1900
                      Budget authority (total)

                      18

                      1930
                      Total budgetary resources available

                      18

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      18

                      3020
                      Outlays (gross)

                      –18

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      18

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      18

                      4180
                      Budget authority, net (total)

                      18

                      4190
                      Outlays, net (total)

                      18

             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, $1,851,450,000: 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 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 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0101
                      Aging Services Programs
                      1,463
                      1,463
                      1,461

                      0102
                      ACL Program Administration
                      40
                      40
                      38

                      0103
                      Integrated Aging and Disability Services Programs
                      119
                      119
                      66

                      0104
                      Disability Services Programs
                      287
                      286
                      216

                      0105
                      National Institute on Disability, Independent Living & Rehab Research
                      104
                      104
                      95

                      0300
                      Total, direct program
                      2,013
                      2,012
                      1,876

                      0799
                      Total direct obligations
                      2,013
                      2,012
                      1,876

                      0801
                      ACL Reimbursable Programs
                      18
                      18
                      18

                      0900
                      Total new obligations, unexpired accounts
                      2,031
                      2,030
                      1,894

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3
                      3
                      34

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      1,912
                      1,909
                      1,851

                      1120
                      Appropriations transferred to other accts [012–3507]
                      –2

                      1120
                      Appropriations transferred to other accts [075–0140]
                      –2

                      1160
                      Appropriation, discretionary (total)
                      1,908
                      1,909
                      1,851

                      Appropriations, mandatory:

                      1221
                      PPHF Appropriations transferred from other accounts [075–0116]
                      28
                      28

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      14
                      62
                      18

                      1701
                      Change in uncollected payments, Federal sources
                      57

                      1750
                      Spending auth from offsetting collections, disc (total)
                      71
                      62
                      18

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      6
                      62
                      25

                      1801
                      Change in uncollected payments, Federal sources
                      19

                      1850
                      Spending auth from offsetting collections, mand (total)
                      25
                      62
                      25

                      1900
                      Budget authority (total)
                      2,032
                      2,061
                      1,894

                      1930
                      Total budgetary resources available
                      2,035
                      2,064
                      1,928

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      3
                      34
                      34

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,245
                      1,261
                      1,211

                      3010
                      New obligations, unexpired accounts
                      2,031
                      2,030
                      1,894

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      5

                      3020
                      Outlays (gross)
                      –2,009
                      –2,080
                      –1,998

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –11

                      3050
                      Unpaid obligations, end of year
                      1,261
                      1,211
                      1,107

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –105
                      –163
                      –163

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –76

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      18

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –163
                      –163
                      –163

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,140
                      1,098
                      1,048

                      3200
                      Obligated balance, end of year
                      1,098
                      1,048
                      944

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,979
                      1,971
                      1,869

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,032
                      1,215
                      1,170

                      4011
                      Outlays from discretionary balances
                      923
                      744
                      748

                      4020
                      Outlays, gross (total)
                      1,955
                      1,959
                      1,918

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –23
                      –62
                      –18

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –57

                      4052
                      Offsetting collections credited to expired accounts
                      9

                      4060
                      Additional offsets against budget authority only (total)
                      –48

                      4070
                      Budget authority, net (discretionary)
                      1,908
                      1,909
                      1,851

                      4080
                      Outlays, net (discretionary)
                      1,932
                      1,897
                      1,900

                      Mandatory:

                      4090
                      Budget authority, gross
                      53
                      90
                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1
                      13
                      5

                      4101
                      Outlays from mandatory balances
                      53
                      108
                      75

                      4110
                      Outlays, gross (total)
                      54
                      121
                      80

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –14
                      –62
                      –25

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –19

                      4142
                      Offsetting collections credited to expired accounts
                      8

                      4150
                      Additional offsets against budget authority only (total)
                      –11

                      4160
                      Budget authority, net (mandatory)
                      28
                      28

                      4170
                      Outlays, net (mandatory)
                      40
                      59
                      55

                      4180
                      Budget authority, net (total)
                      1,936
                      1,937
                      1,851

                      4190
                      Outlays, net (total)
                      1,972
                      1,956
                      1,955

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      1,936
                      1,937
                      1,851

                      Outlays
                      1,972
                      1,956
                      1,955

                      Legislative proposal, subject to PAYGO:

                      Outlays

                      –20

                      Total:

                      Budget Authority
                      1,936
                      1,937
                      1,851

                      Outlays
                      1,972
                      1,956
                      1,935

             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. In FY 2018, a new Partnerships for Innovation, Inclusion, and Independence
                consolidates funding from three disability programs: State Councils on Developmental Disabilities, Traumatic Brain Injury,
                and Independent Living-State Grants. Additionally in FY 2018, a new Alzheimer's Disease Program consolidates funding from
                three Alzheimer's Disease programs: Demo Grants ADSSP, Communications Campaign, and Services.

             Administration for Community Living Program Activity Table Dollars in Millions

                         FY 2018 Program Activity
                         FY 2017 Program Activity
                         FY 2016 Obligations
                         FY 2017 Obligations
                         FY 2018 Obligations

                         0101 Aging Services Programs

                         1,463
                         1,463
                         1,461

                         Home and community-based supportive services
                         348
                         347
                         347

                         Preventive health services
                         20
                         20
                         20

                         National family caregiver support program
                         151
                         150
                         150

                         Native American caregiver support program
                         8
                         8
                         8

                         Congregate nutrition services
                         448
                         447
                         447

                         Home-delivered nutrition services
                         226
                         226
                         226

                         Nutrition services incentive program
                         160
                         160
                         160

                         Native American nutrition and supportive services
                         31
                         31
                         31

                         Long-term care ombudsmen program
                         16
                         16
                         16

                         Prevention of elder abuse and neglect
                         5
                         5
                         5

                         Alzheimer's Disease Demo Grants ADSSP
                         5
                         5
                         0

                         Aging network support activities
                         10
                         10
                         10

                         Elder Rights Support Activities
                         12
                         12
                         12

                         Chronic Disease Self-Management Education Program
                         8
                         8
                         5

                         Falls Prevention
                         5
                         5
                         5

                         Alzheimer's Disease Communications Campaign
                         4
                         4
                         0

                         Alzheimer's Disease Initiative - Services
                         11
                         11
                         0

                         Alzheimer's Disease Program
                         0
                         0
                         19

                         0102 ACL Program Administration

                         40
                         40
                         38

                         Program administration
                         40
                         40
                         38

                         0103 Integrated Aging and Disability Services Programs

                         119
                         119
                         66

                         Assistive Technology
                         34
                         34
                         32

                         Lifespan respite care program
                         3
                         3
                         3

                         SHIP
                         52
                         52
                         0

                         Aging and Disability Resource Centers (ADRC)
                         6
                         6
                         6

                         ARDC's MIPPA (MACRA)
                         5
                         5
                         5

                         Area Agencies on Aging - MIPPA (MACRA)
                         8
                         7
                         8

                         MIPPA - Nat'l Center Benefits Outreach Enrollment (MACRA)
                         12
                         11
                         12

                         0104 Disability Services Programs

                         287
                         286
                         216

                         Voting Access for People With Disabilities (HAVA)
                         5
                         5
                         5

                         Partnerships for Innovation, Inclusion, and Independence
                         0
                         0
                         45

                         State Councils on Developmental Disabilities
                         73
                         73
                         0

                         Protection and Advocacy
                         39
                         39
                         39

                         Traumatic Brain Injury (TBI)
                         9
                         9
                         3

                         Independent Living - State Grants
                         23
                         23
                         0

                         Independent Living - Centers (CILs)
                         78
                         78
                         78

                         University Centers for Excellence in Developmental Disabilities
                         39
                         39
                         39

                         Projects of National Significance
                         10
                         10
                         8

                         Paralysis Resource Center
                         3
                         3
                         0

                         Limb Loss Resource Center
                         8
                         8
                         0

                         0105 National Institute on Disability, Independent Living and Rehab Research

                         104
                         104
                         95

                         National Institute on Disability, Independent Living and Rehab Research
                         104
                         104
                         95

                         0801 ACL Reimbursable Programs

                         18
                         18
                         18

                         Reimbursable program - Other
                         0
                         0
                         0

                         Senior Medicare Patrol/HCFAC Program (Disc - CMS)
                         18
                         18
                         18

          Object Classification (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      22
                      23
                      21

                      12.1
                      Civilian personnel benefits
                      7
                      7
                      7

                      23.1
                      Rental payments to GSA
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      34
                      28
                      26

                      25.3
                      Other goods and services from Federal sources
                      10
                      15
                      15

                      41.0
                      Grants, subsidies, and contributions
                      1,937
                      1,936
                      1,804

                      99.0
                      Direct obligations
                      2,013
                      2,012
                      1,876

                      99.0
                      Reimbursable obligations
                      18
                      18
                      18

                      99.9
                      Total new obligations, unexpired accounts
                      2,031
                      2,030
                      1,894

          Employment Summary

                      Identification code 075–0142–0–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      177
                      192
                      171

                      2001
                      Reimbursable civilian full-time equivalent employment
                      19
                      7
                      10

             Aging and Disability Services Programs

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0142–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0103
                      Integrated Aging and Disability Services Programs

                      25

                      0300
                      Total, direct program

                      25

                      0799
                      Total direct obligations

                      25

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      25

                      1900
                      Budget authority (total)

                      25

                      1930
                      Total budgetary resources available

                      25

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      25

                      3020
                      Outlays (gross)

                      –5

                      3050
                      Unpaid obligations, end of year

                      20

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      20

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      5

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –25

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      –20

          Object Classification (in millions of dollars)

                      Identification code 075–0142–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.3
                      Other goods and services from Federal sources

                      1

                      41.0
                      Grants, subsidies, and contributions

                      23

                      99.0
                      Direct obligations

                      25

                      99.9
                      Total new obligations, unexpired accounts

                      25

          Employment Summary

                      Identification code 075–0142–4–1–506
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      6

             Departmental Management

             Federal Funds
             General departmental managementFor necessary expenses, not otherwise provided, for general departmental management, including the 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, $304,501,000, together with $57,465,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation
                activities: Provided, That of the funds made available under this heading, $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).
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      General Departmental Management
                      456
                      455
                      305

                      0801
                      GDM (Collected)
                      161
                      195
                      198

                      0802
                      HCFAC (Mandatory)
                      8
                      8
                      10

                      0803
                      PHS Evaluation (Collected)
                      65
                      65
                      57

                      0804
                      MACRA (Mandatory)
                      5
                      5
                      5

                      0899
                      Total reimbursable obligations
                      239
                      273
                      270

                      0900
                      Total new obligations, unexpired accounts
                      695
                      728
                      575

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      9
                      9
                      22

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1

                      9

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      456
                      455
                      305

                      1120
                      Appropriations transferred to other accts [075–0943]
                      –1

                      1160
                      Appropriation, discretionary (total)
                      455
                      455
                      305

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      92
                      273
                      270

                      1701
                      Change in uncollected payments, Federal sources
                      136

                      1750
                      Spending auth from offsetting collections, disc (total)
                      228
                      273
                      270

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      5
                      13
                      15

                      1801
                      Change in uncollected payments, Federal sources
                      8

                      1850
                      Spending auth from offsetting collections, mand (total)
                      13
                      13
                      15

                      1900
                      Budget authority (total)
                      696
                      741
                      590

                      1930
                      Total budgetary resources available
                      705
                      750
                      612

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      9
                      22
                      37

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      535
                      517
                      504

                      3010
                      New obligations, unexpired accounts
                      695
                      728
                      575

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      9

                      3020
                      Outlays (gross)
                      –677
                      –741
                      –679

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –45

                      3050
                      Unpaid obligations, end of year
                      517
                      504
                      400

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –220
                      –230
                      –230

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –144

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      134

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –230
                      –230
                      –230

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      315
                      287
                      274

                      3200
                      Obligated balance, end of year
                      287
                      274
                      170

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      683
                      728
                      575

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      333
                      350
                      282

                      4011
                      Outlays from discretionary balances
                      330
                      378
                      382

                      4020
                      Outlays, gross (total)
                      663
                      728
                      664

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –217
                      –273
                      –270

                      4033
                      Non-Federal sources:
                      –3

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –220
                      –273
                      –270

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –136

                      4052
                      Offsetting collections credited to expired accounts
                      128

                      4060
                      Additional offsets against budget authority only (total)
                      –8

                      4070
                      Budget authority, net (discretionary)
                      455
                      455
                      305

                      4080
                      Outlays, net (discretionary)
                      443
                      455
                      394

                      Mandatory:

                      4090
                      Budget authority, gross
                      13
                      13
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      7
                      13
                      15

                      4101
                      Outlays from mandatory balances
                      7

                      4110
                      Outlays, gross (total)
                      14
                      13
                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –6
                      –13
                      –15

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –8

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)
                      –7

                      4170
                      Outlays, net (mandatory)
                      8

                      4180
                      Budget authority, net (total)
                      455
                      455
                      305

                      4190
                      Outlays, net (total)
                      451
                      455
                      394

             Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
                account for 2018. 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.

          Object Classification (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      85
                      85
                      87

                      11.3
                      Other than full-time permanent
                      10
                      10
                      11

                      11.5
                      Other personnel compensation
                      2
                      2
                      2

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      100
                      100
                      103

                      12.1
                      Civilian personnel benefits
                      27
                      27
                      28

                      12.2
                      Military personnel benefits
                      2
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      5
                      5
                      4

                      23.1
                      Rental payments to GSA
                      17
                      17
                      16

                      23.3
                      Communications, utilities, and miscellaneous charges
                      2
                      2
                      2

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      22
                      22
                      19

                      25.2
                      Other services from non-Federal sources
                      42
                      42
                      41

                      25.3
                      Other goods and services from Federal sources
                      70
                      70
                      33

                      25.4
                      Operation and maintenance of facilities
                      6
                      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
                      155
                      155
                      44

                      99.0
                      Direct obligations
                      456
                      455
                      305

                      99.0
                      Reimbursable obligations
                      239
                      273
                      270

                      99.9
                      Total new obligations, unexpired accounts
                      695
                      728
                      575

          Employment Summary

                      Identification code 075–9912–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      902
                      965
                      971

                      1101
                      Direct military average strength employment
                      25
                      27
                      26

                      2001
                      Reimbursable civilian full-time equivalent employment
                      527
                      541
                      546

                      2101
                      Reimbursable military average strength employment
                      28
                      24
                      24

             General Departmental Management

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–9912–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0805
                      DAB (Mandatory)

                      2

                      0899
                      Total reimbursable obligations

                      2

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      2

                      1930
                      Total budgetary resources available

                      2

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      2

                      3020
                      Outlays (gross)

                      –2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This legislative proposal provides the Departmental Appeals Board (DAB) mandatory resources to address the Medicare appeals
                backlog.

          Object Classification (in millions of dollars)

                      Identification code 075–9912–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      11.1
                      Reimbursable obligations: Personnel compensation: Full-time permanent

                      1

                      11.9
                      Total personnel compensation

                      1

                      25.3
                      Other goods and services from Federal sources

                      1

                      99.0
                      Reimbursable obligations

                      2

                      99.9
                      Total new obligations, unexpired accounts

                      2

          Employment Summary

                      Identification code 075–9912–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      14

             Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0146–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Opioid Funding

                      500
                      500

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)

                      500
                      500

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      500
                      500

                      1930
                      Total budgetary resources available

                      500
                      500

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      500
                      500

                      3020
                      Outlays (gross)

                      –500
                      –500

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      500
                      500

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      500
                      500

                      4180
                      Budget authority, net (total)

                      500
                      500

                      4190
                      Outlays, net (total)

                      500
                      500

             This account, and a related special receipt account, were established to support the execution structure necessary to implement
                the 21st Century Cures Act.

             State Response to the Opioid Abuse Crisis, CURES Act For necessary expenses to carry out the purposes described under section 1003(c) of the 21st Century Cures Act, $500,000,000,
                   to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1003(b)(3) of the 21st
                   Century Cures Act, are to be derived from amounts transferred under section 1003(b)(2)(A) of such Act, and may be transferred
                   by the Secretary of Health and Human Services to other accounts of the Department solely for the purposes provided in such
                   Act: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, State Response to the Opioid Abuse Crisis, CURES Act

                      500
                      500

                      2000
                      Total: Balances and receipts

                      500
                      500

                      Appropriations:

                      Current law:

                      2101
                      State Response to the Opioid Abuse Crisis, Cures Act

                      –500
                      –500

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)

                      500
                      500

                      1120
                      Appropriations transferred to other acct [075–1362]

                      –500
                      –500

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This program provides grants to states, the District of Columbia, and territories to develop and provide opioid abuse prevention,
                treatment, and recovery support services.

             Office for civil rightsFor expenses necessary for the Office for Civil Rights, $32,530,000.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Office for Civil Rights (Direct)
                      39
                      39
                      33

                      0801
                      Office for Civil Rights (Reimbursable)
                      6
                      14
                      11

                      0900
                      Total new obligations, unexpired accounts
                      45
                      53
                      44

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      4
                      24
                      17

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      39
                      39
                      33

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected

                      1

                      1701
                      Change in uncollected payments, Federal sources
                      1
                      –1

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      26
                      8
                      10

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –1
                      –1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      25
                      7
                      10

                      1900
                      Budget authority (total)
                      65
                      46
                      43

                      1930
                      Total budgetary resources available
                      69
                      70
                      60

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      24
                      17
                      16

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      10
                      12
                      15

                      3010
                      New obligations, unexpired accounts
                      45
                      53
                      44

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1

                      3020
                      Outlays (gross)
                      –42
                      –50
                      –43

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      12
                      15
                      16

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1

                      –1

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –1
                      1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      10
                      11
                      15

                      3200
                      Obligated balance, end of year
                      11
                      15
                      16

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      40
                      39
                      33

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      34
                      31
                      26

                      4011
                      Outlays from discretionary balances
                      6
                      12
                      7

                      4020
                      Outlays, gross (total)
                      40
                      43
                      33

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources

                      –1

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –1
                      1

                      4060
                      Additional offsets against budget authority only (total)
                      –1
                      1

                      4070
                      Budget authority, net (discretionary)
                      39
                      39
                      33

                      4080
                      Outlays, net (discretionary)
                      40
                      42
                      33

                      Mandatory:

                      4090
                      Budget authority, gross
                      25
                      7
                      10

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      7
                      10

                      4101
                      Outlays from mandatory balances
                      2

                      4110
                      Outlays, gross (total)
                      2
                      7
                      10

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –26
                      –8
                      –10

                      4180
                      Budget authority, net (total)
                      38
                      38
                      33

                      4190
                      Outlays, net (total)
                      16
                      41
                      33

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections

                      1
                      2

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      2
                      2

             The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination, health information
                privacy, and security compliance programs.

          Object Classification (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      16
                      16
                      16

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      17
                      17
                      17

                      12.1
                      Civilian personnel benefits
                      6
                      6
                      5

                      21.0
                      Travel and transportation of persons
                      1
                      1

                      23.1
                      Rental payments to GSA
                      3
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      1
                      1
                      1

                      25.3
                      Other goods and services from Federal sources
                      10
                      10
                      6

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      99.0
                      Direct obligations
                      39
                      39
                      33

                      99.0
                      Reimbursable obligations
                      6
                      14
                      11

                      99.9
                      Total new obligations, unexpired accounts
                      45
                      53
                      44

          Employment Summary

                      Identification code 075–0135–0–1–751
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      168
                      177
                      161

                      1101
                      Direct military average strength employment
                      2
                      2
                      1

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1
                      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, $38,381,000.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Health information technology (IT)
                      60
                      60
                      38

                      0002
                      Recovery Act activities
                      6

                      0799
                      Total direct obligations
                      66
                      60
                      38

                      0801
                      Office of the National Coordinator for Health IT (ONC): Reimbursable
                      17
                      20
                      15

                      0899
                      Total reimbursable obligations
                      17
                      20
                      15

                      0900
                      Total new obligations, unexpired accounts
                      83
                      80
                      53

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      6

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      60
                      60
                      38

                      Spending authority from offsetting collections, discretionary:

                      1700
                      PHS and Other
                      7
                      20
                      15

                      1701
                      Change in uncollected payments, Federal sources
                      10

                      1750
                      Spending auth from offsetting collections, disc (total)
                      17
                      20
                      15

                      1900
                      Budget authority (total)
                      77
                      80
                      53

                      1930
                      Total budgetary resources available
                      83
                      80
                      53

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      121
                      95
                      27

                      3010
                      New obligations, unexpired accounts
                      83
                      80
                      53

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1

                      3020
                      Outlays (gross)
                      –105
                      –148
                      –58

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      95
                      27
                      22

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –30
                      –26
                      –26

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –10

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      14

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –26
                      –26
                      –26

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      91
                      69
                      1

                      3200
                      Obligated balance, end of year
                      69
                      1
                      –4

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      77
                      80
                      53

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      50
                      68
                      45

                      4011
                      Outlays from discretionary balances
                      55
                      80
                      13

                      4020
                      Outlays, gross (total)
                      105
                      148
                      58

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –20
                      –20
                      –15

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –20
                      –20
                      –15

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –10

                      4052
                      Offsetting collections credited to expired accounts
                      13

                      4060
                      Additional offsets against budget authority only (total)
                      3

                      4070
                      Budget authority, net (discretionary)
                      60
                      60
                      38

                      4080
                      Outlays, net (discretionary)
                      85
                      128
                      43

                      4180
                      Budget authority, net (total)
                      60
                      60
                      38

                      4190
                      Outlays, net (total)
                      85
                      128
                      43

             This program supports coordination, leadership, and development of Federal health information technology activities and Federal
                initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation
                with participants in the health sector. The Office of the National Coordinator for Health Information Technology was established
                in the Health Information Technology for Economic and Clinical Health Act (P.L. 111–5, Title XIII), for the purpose of addressing
                strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private
                adoption of health information technology.

          Object Classification (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      17
                      19
                      17

                      11.3
                      Other than full-time permanent
                      2
                      3
                      2

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      20
                      23
                      20

                      12.1
                      Civilian personnel benefits
                      6
                      7
                      5

                      23.1
                      Rental payments to GSA
                      3
                      3
                      2

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      15
                      12
                      4

                      25.3
                      Other goods and services from Federal sources
                      12
                      11
                      5

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      7
                      1

                      99.0
                      Direct obligations
                      66
                      60
                      38

                      99.0
                      Reimbursable obligations
                      17
                      20
                      15

                      99.9
                      Total new obligations, unexpired accounts
                      83
                      80
                      53

          Employment Summary

                      Identification code 075–0130–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      174
                      188
                      162

                      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,  $117,177,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
                Insurance Trust Fund.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0139–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Office of Medicare Hearings and Appeals (Direct)
                      106
                      107
                      117

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      71
                      107
                      117

                      1701
                      Change in uncollected payments, Federal sources
                      36

                      1750
                      Spending auth from offsetting collections, disc (total)
                      107
                      107
                      117

                      1930
                      Total budgetary resources available
                      107
                      107
                      117

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      19
                      29
                      1

                      3010
                      New obligations, unexpired accounts
                      106
                      107
                      117

                      3020
                      Outlays (gross)
                      –94
                      –135
                      –117

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      29
                      1
                      1

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –26
                      –42
                      –42

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –36

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      20

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –42
                      –42
                      –42

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –7
                      –13
                      –41

                      3200
                      Obligated balance, end of year
                      –13
                      –41
                      –41

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      107
                      107
                      117

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      81
                      107
                      117

                      4011
                      Outlays from discretionary balances
                      13
                      28

                      4020
                      Outlays, gross (total)
                      94
                      135
                      117

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –91
                      –107
                      –117

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –36

                      4052
                      Offsetting collections credited to expired accounts
                      20

                      4060
                      Additional offsets against budget authority only (total)
                      –16

                      4080
                      Outlays, net (discretionary)
                      3
                      28

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      3
                      28

             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 075–0139–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      49
                      60
                      64

                      12.1
                      Civilian personnel benefits
                      17
                      21
                      21

                      22.0
                      Transportation of things
                      1

                      1

                      23.1
                      Rental payments to GSA
                      8
                      8
                      8

                      23.3
                      Communications, utilities, and miscellaneous charges
                      4
                      4
                      5

                      25.2
                      Other services from non-Federal sources
                      9
                      2
                      6

                      25.3
                      Other goods and services from Federal sources
                      9
                      8
                      8

                      25.4
                      Operation and maintenance of facilities
                      7
                      1
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      26.0
                      Supplies and materials

                      1
                      1

                      31.0
                      Equipment
                      1
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      106
                      107
                      117

          Employment Summary

                      Identification code 075–0139–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      557
                      671
                      725

             Office of Medicare Hearings and Appeals

             (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)

                      Identification code 075–0139–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Reimbursable program activity

                      125

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      125

                      1930
                      Total budgetary resources available

                      125

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      125

                      3020
                      Outlays (gross)

                      –125

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      125

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      125

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –125

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             This legislative proposal provides the Office of Medicare Hearings and Appeals (OMHA) mandatory resources to address the Medicare
                appeals backlog.

          Object Classification (in millions of dollars)

                      Identification code 075–0139–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Reimbursable obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      23

                      12.1
                      Civilian personnel benefits

                      8

                      22.0
                      Transportation of things

                      1

                      23.1
                      Rental payments to GSA

                      4

                      23.3
                      Communications, utilities, and miscellaneous charges

                      9

                      25.2
                      Other services from non-Federal sources

                      20

                      25.3
                      Other goods and services from Federal sources

                      9

                      25.4
                      Operation and maintenance of facilities

                      38

                      25.7
                      Operation and maintenance of equipment

                      5

                      26.0
                      Supplies and materials

                      2

                      31.0
                      Equipment

                      6

                      99.9
                      Total new obligations, unexpired accounts

                      125

          Employment Summary

                      Identification code 075–0139–4–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment

                      255

             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, $945,753,000, of which $511,700,000 shall remain available until expended 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,
                2020: Provided further, That in making awards under section 319C-2 of the PHS Act from funds made available in this paragraph,
                   the Secretary may determine the amounts of such awards without regard to subsection (j)(3)(B) of such section: 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 made available 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,
                to remain available until expended: Provided, That up to 10 percent of the amounts made available in this paragraph may also be used to supplement funds made
                   available 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, $206,863,000; of which $174,924,000 shall be available until expended, for activities including the development and purchase of vaccines, antivirals, necessary medical supplies, diagnostics, and other surveillance tools: Provided, That 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0140–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Public Health and Social Services Emergency Fund
                      1,777
                      2,003
                      1,653

                      0100
                      Direct program activities, subtotal
                      1,777
                      2,003
                      1,653

                      0801
                      Reimbursable program (FEMA)
                      18
                      80
                      80

                      0802
                      Reimbursable program activity (OPP)
                      2
                      2

                      0899
                      Total reimbursable obligations
                      20
                      82
                      80

                      0900
                      Total new obligations, unexpired accounts
                      1,797
                      2,085
                      1,733

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      825
                      945
                      469

                      1010
                      Unobligated balance transfer to other accts [075–0343]
                      –2
                      –3
                      –3

                      1010
                      Unobligated balance transfer to other accts [075–0943]
                      –15

                      1010
                      Unobligated balance transfer to other accts [075–0943]
                      –10

                      1010
                      Unobligated balance transfer to other accts [075–9915]
                      –4

                      1010
                      Unobligated balance transfer to other accts [075–9915]
                      –47

                      1011
                      Unobligated balance transfer from other acct [075–0943]
                      14

                      1021
                      Recoveries of prior year unpaid obligations
                      15

                      1050
                      Unobligated balance (total)
                      776
                      942
                      466

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      1,533
                      1,530
                      1,663

                      1100
                      Appropriation - Emergency Pursuant to 2011 BCA
                      387

                      1121
                      Appropriations transferred from other acct [075–1502]
                      19

                      1121
                      Appropriations transferred from other acct [075–0350]
                      7

                      1121
                      Appropriations transferred from other acct [075–0142]
                      2

                      1160
                      Appropriation, discretionary (total)
                      1,948
                      1,530
                      1,663

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      4
                      82
                      82

                      1701
                      Change in uncollected payments, Federal sources
                      17

                      1750
                      Spending auth from offsetting collections, disc (total)
                      21
                      82
                      82

                      1900
                      Budget authority (total)
                      1,969
                      1,612
                      1,745

                      1930
                      Total budgetary resources available
                      2,745
                      2,554
                      2,211

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –3

                      1941
                      Unexpired unobligated balance, end of year
                      945
                      469
                      478

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      4,052
                      4,269
                      3,480

                      3010
                      New obligations, unexpired accounts
                      1,797
                      2,085
                      1,733

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      5

                      3020
                      Outlays (gross)
                      –1,537
                      –2,874
                      –1,818

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –15

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –33

                      3050
                      Unpaid obligations, end of year
                      4,269
                      3,480
                      3,395

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –83
                      –81
                      –81

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –17

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      19

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –81
                      –81
                      –81

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3,969
                      4,188
                      3,399

                      3200
                      Obligated balance, end of year
                      4,188
                      3,399
                      3,314

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,969
                      1,612
                      1,745

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      245
                      488
                      504

                      4011
                      Outlays from discretionary balances
                      1,292
                      2,386
                      1,314

                      4020
                      Outlays, gross (total)
                      1,537
                      2,874
                      1,818

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –12
                      –82
                      –82

                      4033
                      Non-Federal sources
                      –9

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –21
                      –82
                      –82

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –17

                      4052
                      Offsetting collections credited to expired accounts
                      17

                      4070
                      Budget authority, net (discretionary)
                      1,948
                      1,530
                      1,663

                      4080
                      Outlays, net (discretionary)
                      1,516
                      2,792
                      1,736

                      4180
                      Budget authority, net (total)
                      1,948
                      1,530
                      1,663

                      4190
                      Outlays, net (total)
                      1,516
                      2,792
                      1,736

             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 075–0140–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      66
                      96
                      101

                      11.3
                      Other than full-time permanent
                      18

                      11.7
                      Military personnel
                      8
                      7
                      7

                      11.9
                      Total personnel compensation
                      92
                      103
                      108

                      12.1
                      Civilian personnel benefits
                      23
                      36
                      39

                      12.2
                      Military personnel benefits
                      4
                      3
                      3

                      21.0
                      Travel and transportation of persons
                      7
                      6
                      9

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      15
                      19
                      20

                      23.3
                      Communications, utilities, and miscellaneous charges
                      5
                      1
                      1

                      25.1
                      Advisory and assistance services
                      585
                      468
                      515

                      25.2
                      Other services from non-Federal sources
                      144
                      94
                      32

                      25.3
                      Other goods and services from Federal sources
                      74
                      109
                      114

                      25.4
                      Operation and maintenance of facilities
                      3
                      4
                      4

                      25.5
                      Research and development contracts
                      77
                      806
                      452

                      25.7
                      Operation and maintenance of equipment
                      21
                      45
                      68

                      26.0
                      Supplies and materials
                      441
                      2
                      2

                      31.0
                      Equipment
                      2
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      283
                      305
                      284

                      99.0
                      Direct obligations
                      1,777
                      2,003
                      1,653

                      99.0
                      Reimbursable obligations
                      20
                      82
                      80

                      99.9
                      Total new obligations, unexpired accounts
                      1,797
                      2,085
                      1,733

          Employment Summary

                      Identification code 075–0140–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      640
                      675
                      705

                      1101
                      Direct military average strength employment
                      74
                      75
                      75

             Transfers from the Patient-Centered Outcomes Research Trust Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      AHRQ
                      98
                      99

                      0002
                      Office of the Secretary
                      18
                      33
                      25

                      0003
                      NIRSQ

                      104

                      0900
                      Total new obligations, unexpired accounts
                      116
                      132
                      129

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      52
                      54
                      38

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      53
                      54
                      38

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      117
                      116
                      133

                      1930
                      Total budgetary resources available
                      170
                      170
                      171

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      54
                      38
                      42

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      134
                      153
                      215

                      3010
                      New obligations, unexpired accounts
                      116
                      132
                      129

                      3020
                      Outlays (gross)
                      –96
                      –70
                      –87

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      153
                      215
                      257

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      134
                      153
                      215

                      3200
                      Obligated balance, end of year
                      153
                      215
                      257

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      117
                      116
                      133

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      5
                      3
                      4

                      4101
                      Outlays from mandatory balances
                      91
                      67
                      83

                      4110
                      Outlays, gross (total)
                      96
                      70
                      87

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –117
                      –116
                      –133

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –21
                      –46
                      –46

             Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
                20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and
                Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
                from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
                and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research.
                Transferred funds were distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality through FY 2017
                to carry out these activities. The FY 2018 Budget consolidates the Agency for Healthcare Research and Quality within the National
                Institutes of Health as the National Institute for Research on Safety and Quality. This Institute is proposed to receive the
                resources from the PCORTF that the Agency for Healthcare Research and Quality would have received under current law.

          Object Classification (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      2
                      3
                      3

                      25.1
                      Advisory and assistance services
                      19
                      19
                      23

                      25.3
                      Other goods and services from Federal sources
                      18
                      32
                      25

                      41.0
                      Grants, subsidies, and contributions
                      77
                      78
                      78

                      99.9
                      Total new obligations, unexpired accounts
                      116
                      132
                      129

          Employment Summary

                      Identification code 075–0145–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4
                      4

             Nonrecurring Expenses Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0125–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Nonrecurring Expenses Fund Projects
                      594
                      694
                      228

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      871
                      830
                      444

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      550
                      708
                      344

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      1,424
                      1,538
                      788

                      Budget authority:

                      Appropriations, discretionary:

                      1120
                      Appropriations transferred to other acct [075–1503]

                      –300

                      1131
                      Unobligated balance of appropriations permanently reduced

                      –100
                      –560

                      1160
                      Appropriation, discretionary (total):

                      –400
                      –560

                      1930
                      Total budgetary resources available
                      1,424
                      1,138
                      228

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      830
                      444

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      349
                      536
                      854

                      3010
                      New obligations, unexpired accounts
                      594
                      694
                      228

                      3020
                      Outlays (gross)
                      –404
                      –376
                      530

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3050
                      Unpaid obligations, end of year
                      536
                      854
                      1,612

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      349
                      536
                      854

                      3200
                      Obligated balance, end of year
                      536
                      854
                      1,612

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –400
                      –560

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      –100
                      –560

                      4011
                      Outlays from discretionary balances
                      404
                      476
                      30

                      4020
                      Outlays, gross (total)
                      404
                      376
                      –530

                      4180
                      Budget authority, net (total)

                      –400
                      –560

                      4190
                      Outlays, net (total)
                      404
                      376
                      –530

             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 075–0125–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      75
                      87
                      29

                      25.2
                      Other services from non-Federal sources
                      249
                      291
                      96

                      25.3
                      Other goods and services from Federal sources
                      155
                      181
                      59

                      25.4
                      Operation and maintenance of facilities
                      54
                      63
                      21

                      25.5
                      Research and development contracts
                      3
                      4
                      1

                      25.7
                      Operation and maintenance of equipment
                      27
                      32
                      10

                      31.0
                      Equipment
                      20
                      23
                      8

                      32.0
                      Land and structures
                      9
                      11
                      3

                      99.0
                      Direct obligations
                      593
                      693
                      228

                      99.5
                      Adjustment for rounding
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      594
                      694
                      228

          Employment Summary

                      Identification code 075–0125–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4

             Health Insurance Reform Implementation Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0119–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Health Insurance Reform Implementation Fund (Direct)
                      4

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)
                      4

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      5
                      5
                      5

                      1021
                      Recoveries of prior year unpaid obligations
                      4

                      1050
                      Unobligated balance (total)
                      9
                      5
                      5

                      1930
                      Total budgetary resources available
                      9
                      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
                      33
                      19
                      1

                      3010
                      New obligations, unexpired accounts
                      4

                      3020
                      Outlays (gross)
                      –14
                      –18

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –4

                      3050
                      Unpaid obligations, end of year
                      19
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      33
                      19
                      1

                      3200
                      Obligated balance, end of year
                      19
                      1
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      14
                      18

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      14
                      18

             Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the
                Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
                Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
                of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.

             Prevention and Public Health Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0116–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,000
                      1,000
                      900

                      1220
                      Appropriations transferred to other accts [075–0142]
                      –28
                      –28

                      1220
                      Appropriations transferred to other accts [075–0943]
                      –892
                      –891
                      –841

                      1220
                      Appropriations transferred to other accts [075–1362]
                      –12
                      –12

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                      –68
                      –69
                      –59

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The Prevention and Public Health Fund supports prevention and public health activities. In FY 2018, $837 million 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 075–0117–0–1–551
                      2016 actual
                      2017 est.
                      2018 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
                      –2
                      –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
                      29
                      27
                      24

                      3010
                      New obligations, unexpired accounts
                      23
                      23
                      25

                      3020
                      Outlays (gross)
                      –25
                      –26
                      –24

                      3050
                      Unpaid obligations, end of year
                      27
                      24
                      25

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      29
                      27
                      24

                      3200
                      Obligated balance, end of year
                      27
                      24
                      25

                      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
                      23
                      25
                      23

                      4110
                      Outlays, gross (total)
                      25
                      26
                      24

                      4180
                      Budget authority, net (total)
                      23
                      23
                      25

                      4190
                      Outlays, net (total)
                      25
                      26
                      24

             For awarding competitive grants to States to assist pregnant and parenting teens and women.

          Object Classification (in millions of dollars)

                      Identification code 075–0117–0–1–551
                      2016 actual
                      2017 est.
                      2018 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, unexpired accounts
                      23
                      23
                      25

          Employment Summary

                      Identification code 075–0117–0–1–551
                      2016 actual
                      2017 est.
                      2018 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 075–3902–0–1–552
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Section 241 Evaluation Transactions Account (Reimbursable)
                      473
                      473
                      425

                      0809
                      Reimbursable program activities, subtotal
                      473
                      473
                      425

                      0900
                      Total new obligations (object class 25.3)
                      473
                      473
                      425

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      91
                      473
                      425

                      1701
                      Change in uncollected payments, Federal sources
                      382

                      1750
                      Spending auth from offsetting collections, disc (total)
                      473
                      473
                      425

                      1930
                      Total budgetary resources available
                      473
                      473
                      425

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      738
                      906
                      279

                      3010
                      New obligations, unexpired accounts
                      473
                      473
                      425

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      4

                      3020
                      Outlays (gross)
                      –309
                      –1,100
                      –659

                      3050
                      Unpaid obligations, end of year
                      906
                      279
                      45

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –739
                      –923
                      –923

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –382

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      198

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –923
                      –923
                      –923

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –1
                      –17
                      –644

                      3200
                      Obligated balance, end of year
                      –17
                      –644
                      –878

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      473
                      473
                      425

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      91
                      473
                      425

                      4011
                      Outlays from discretionary balances
                      218
                      627
                      234

                      4020
                      Outlays, gross (total)
                      309
                      1,100
                      659

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –293
                      –473
                      –425

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –293
                      –473
                      –425

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –382

                      4052
                      Offsetting collections credited to expired accounts
                      202

                      4060
                      Additional offsets against budget authority only (total)
                      –180

                      4080
                      Outlays, net (discretionary)
                      16
                      627
                      234

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      16
                      627
                      234

             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 chapter 55 of title 10, United States Code, such amounts as may be required during the current fiscal year.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0379–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Retirement payments
                      433
                      441
                      456

                      0002
                      Survivors' benefits
                      29
                      30
                      32

                      0003
                      Medical care
                      128
                      123
                      131

                      0900
                      Total new obligations, unexpired accounts
                      590
                      594
                      619

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      597
                      594
                      619

                      1930
                      Total budgetary resources available
                      597
                      594
                      619

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –7

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      70
                      64
                      64

                      3010
                      New obligations, unexpired accounts
                      590
                      594
                      619

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      11

                      3020
                      Outlays (gross)
                      –592
                      –594
                      –649

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –15

                      3050
                      Unpaid obligations, end of year
                      64
                      64
                      34

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      70
                      64
                      64

                      3200
                      Obligated balance, end of year
                      64
                      64
                      34

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      597
                      594
                      619

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      541
                      564
                      588

                      4101
                      Outlays from mandatory balances
                      51
                      30
                      61

                      4110
                      Outlays, gross (total)
                      592
                      594
                      649

                      4180
                      Budget authority, net (total)
                      597
                      594
                      619

                      4190
                      Outlays, net (total)
                      592
                      594
                      649

             The number of beneficiaries using the Commissioned Corps system is estimated as follows:
             Retirement Pay, Survivor Benefits, and Medical Benefits

                         2016
                         2017
                         2018

                         Active Duty:

                         HHS
                         4945
                         4904
                         4889

                         DOJ, BOP
                         865
                         879
                         879

                         Homeland Security
                         454
                         505
                         644

                         EPA
                         56
                         58
                         50

                         All Other
                         274
                         262
                         271

                         Total Active Duty
                         6594
                         6608
                         6733

                         Retirees & Survivors:

                         Retirees
                         6130
                         6130
                         6200

                         Retiree family members and survivors
                         1097
                         1097
                         1105

                         Total Retirement Pay
                         7227
                         7227
                         7305

                         Total Beneficiaries (active duty, retirees, survivors)
                         13821
                         13962
                         14720

             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 075–0379–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      13.0
                      Benefits for former personnel
                      462
                      472
                      488

                      25.6
                      Medical care
                      128
                      122
                      131

                      99.9
                      Total new obligations, unexpired accounts
                      590
                      594
                      619

             HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0170–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Medicare eligible accruals
                      26
                      28
                      32

                      0900
                      Total new obligations (object class 12.2)
                      26
                      28
                      32

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      26
                      28
                      32

                      1930
                      Total budgetary resources available
                      26
                      28
                      32

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      26
                      28
                      32

                      3020
                      Outlays (gross)
                      –26
                      –28
                      –32

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      26
                      28
                      32

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      26
                      28
                      32

                      4180
                      Budget authority, net (total)
                      26
                      28
                      32

                      4190
                      Outlays, net (total)
                      26
                      28
                      32

          Summary of Budget Authority and Outlays (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Enacted/requested:

                      Budget Authority
                      26
                      28
                      32

                      Outlays
                      26
                      28
                      32

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –1

                      Outlays

                      –1

                      Total:

                      Budget Authority
                      26
                      28
                      31

                      Outlays
                      26
                      28
                      31

             The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
                Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
                appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).

             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 075–0170–2–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Medicare eligible accruals

                      –1

                      0900
                      Total new obligations (object class 12.2)

                      –1

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation

                      –1

                      1930
                      Total budgetary resources available

                      –1

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1

                      3020
                      Outlays (gross)

                      1

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –1

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      –1

                      4180
                      Budget authority, net (total)

                      –1

                      4190
                      Outlays, net (total)

                      –1

             Health Activities Funds

             Program and Financing (in millions of dollars)

                      Identification code 075–9913–0–1–551
                      2016 actual
                      2017 est.
                      2018 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 075–9941–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0801
                      Program Support Center
                      918
                      1,001
                      933

                      0802
                      OS activities
                      435
                      476
                      463

                      0900
                      Total new obligations, unexpired accounts
                      1,353
                      1,477
                      1,396

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      115
                      181
                      17

                      1021
                      Recoveries of prior year unpaid obligations
                      84
                      45
                      181

                      1050
                      Unobligated balance (total)
                      199
                      226
                      198

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,303
                      1,268
                      1,251

                      1701
                      Change in uncollected payments, Federal sources
                      32

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,335
                      1,268
                      1,251

                      1930
                      Total budgetary resources available
                      1,534
                      1,494
                      1,449

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      181
                      17
                      53

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      791
                      909
                      209

                      3010
                      New obligations, unexpired accounts
                      1,353
                      1,477
                      1,396

                      3020
                      Outlays (gross)
                      –1,151
                      –2,132
                      –1,251

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –84
                      –45
                      –181

                      3050
                      Unpaid obligations, end of year
                      909
                      209
                      173

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –428
                      –460
                      –460

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –32

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –460
                      –460
                      –460

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      363
                      449
                      –251

                      3200
                      Obligated balance, end of year
                      449
                      –251
                      –287

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,335
                      1,268
                      1,251

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      648
                      1,268
                      1,251

                      4011
                      Outlays from discretionary balances
                      503
                      864

                      4020
                      Outlays, gross (total)
                      1,151
                      2,132
                      1,251

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –1,295
                      –1,268
                      –1,251

                      4033
                      Non-Federal sources
                      –8

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,303
                      –1,268
                      –1,251

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –32

                      4080
                      Outlays, net (discretionary)
                      –152
                      864

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –152
                      864

             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 075–9941–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      92
                      100
                      102

                      11.3
                      Other than full-time permanent
                      4
                      4
                      4

                      11.5
                      Other personnel compensation
                      2
                      2
                      2

                      11.7
                      Military personnel
                      6
                      6
                      6

                      11.8
                      Special personal services payments
                      9
                      2

                      11.9
                      Total personnel compensation
                      113
                      114
                      114

                      12.1
                      Civilian personnel benefits
                      30
                      33
                      35

                      12.2
                      Military personnel benefits
                      3
                      3
                      3

                      21.0
                      Travel and transportation of persons
                      1
                      2
                      2

                      22.0
                      Transportation of things
                      2
                      4
                      4

                      23.1
                      Rental payments to GSA
                      23
                      22
                      22

                      23.3
                      Communications, utilities, and miscellaneous charges
                      9
                      9
                      8

                      24.0
                      Printing and reproduction
                      8
                      8
                      8

                      25.1
                      Advisory and assistance services
                      33
                      23
                      23

                      25.2
                      Other services from non-Federal sources
                      815
                      941
                      889

                      25.3
                      Other goods and services from Federal sources
                      167
                      171
                      141

                      25.4
                      Operation and maintenance of facilities
                      12
                      13
                      13

                      25.6
                      Medical care
                      23
                      24
                      24

                      25.7
                      Operation and maintenance of equipment
                      58
                      56
                      56

                      26.0
                      Supplies and materials
                      49
                      46
                      46

                      31.0
                      Equipment
                      7
                      8
                      8

                      99.9
                      Total new obligations, unexpired accounts
                      1,353
                      1,477
                      1,396

          Employment Summary

                      Identification code 075–9941–0–4–551
                      2016 actual
                      2017 est.
                      2018 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      924
                      974
                      987

                      2101
                      Reimbursable military average strength employment
                      62
                      62
                      62

                      3101
                      Allocation account military average strength employment
                      1,593
                      1,646
                      1,794

          Trust Funds
             Miscellaneous Trust Funds

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      0100
                      Balance, start of year

                      10

                      Receipts:

                      Current law:

                      1130
                      Contributions, Indian Health Facilities
                      4
                      48
                      48

                      1130
                      Contributions, N.I.H., Unconditional Gift Fund
                      3
                      3
                      3

                      1130
                      Centers for Disease Control, Gifts and Donations
                      23
                      15
                      15

                      1130
                      Contributions, N.I.H., Conditional Gift Fund
                      51
                      27
                      27

                      1130
                      Contributions to the Indian Health Service Gift Fund

                      1
                      1

                      1140
                      Interest, Miscellaneous Trust Funds
                      1
                      1
                      1

                      1198
                      Rounding adjustment
                      2

                      1199
                      Total current law receipts
                      84
                      95
                      95

                      1999
                      Total receipts
                      84
                      95
                      95

                      2000
                      Total: Balances and receipts
                      84
                      95
                      105

                      Appropriations:

                      Current law:

                      2101
                      Miscellaneous Trust Funds
                      –84
                      –85
                      –84

                      2103
                      Miscellaneous Trust Funds

                      –3
                      –3

                      2132
                      Miscellaneous Trust Funds

                      3

                      2199
                      Total current law appropriations
                      –84
                      –85
                      –87

                      2999
                      Total appropriations
                      –84
                      –85
                      –87

                      5099
                      Balance, end of year

                      10
                      18

          Program and Financing (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0002
                      Gifts
                      110
                      110
                      110

                      0003
                      Contributions, Indian Health Facilities
                      9
                      9
                      9

                      0900
                      Total new obligations, unexpired accounts
                      119
                      119
                      119

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      164
                      198
                      233

                      1021
                      Recoveries of prior year unpaid obligations
                      8
                      8
                      8

                      1033
                      Recoveries of prior year paid obligations
                      61
                      61
                      61

                      1050
                      Unobligated balance (total)
                      233
                      267
                      302

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      84
                      85
                      84

                      1203
                      Appropriation (previously unavailable)

                      3
                      3

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced

                      –3

                      1260
                      Appropriations, mandatory (total)
                      84
                      85
                      87

                      1930
                      Total budgetary resources available
                      317
                      352
                      389

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      198
                      233
                      270

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      93
                      63
                      31

                      3010
                      New obligations, unexpired accounts
                      119
                      119
                      119

                      3020
                      Outlays (gross)
                      –141
                      –143
                      –141

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –8
                      –8
                      –8

                      3050
                      Unpaid obligations, end of year
                      63
                      31
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      93
                      63
                      31

                      3200
                      Obligated balance, end of year
                      63
                      31
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      84
                      85
                      87

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6
                      8
                      8

                      4101
                      Outlays from mandatory balances
                      135
                      135
                      133

                      4110
                      Outlays, gross (total)
                      141
                      143
                      141

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –61
                      –61
                      –61

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      61
                      61
                      61

                      4160
                      Budget authority, net (mandatory)
                      84
                      85
                      87

                      4170
                      Outlays, net (mandatory)
                      80
                      82
                      80

                      4180
                      Budget authority, net (total)
                      84
                      85
                      87

                      4190
                      Outlays, net (total)
                      80
                      82
                      80

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      28
                      21
                      21

                      5001
                      Total investments, EOY: Federal securities: Par value
                      21
                      21
                      21

             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 075–9971–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      4
                      4
                      4

                      11.8
                      Special personal services payments
                      6
                      6
                      6

                      11.9
                      Total personnel compensation
                      10
                      10
                      10

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      4
                      4
                      4

                      25.2
                      Other services from non-Federal sources
                      19
                      19
                      19

                      25.5
                      Research and development contracts
                      4
                      4
                      4

                      25.6
                      Medical care
                      5
                      5
                      5

                      26.0
                      Supplies and materials
                      4
                      4
                      4

                      31.0
                      Equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      68
                      68
                      68

                      99.9
                      Total new obligations, unexpired accounts
                      119
                      119
                      119

          Employment Summary

                      Identification code 075–9971–0–7–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      35
                      35
                      35

             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, $68,085,000: 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.
          Note.—A full-year 2017 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Further Continuing Appropriations Act, 2017 (P.L. 114–254). The amounts
             included for 2017 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0128–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Obligations by program activity:

                      0001
                      Office of Inspector General (Direct)
                      76
                      76
                      68

                      0801
                      OIG HCFAC Trust Fund
                      194
                      210
                      230

                      0802
                      OIG Direct Reimbursable activity
                      14
                      21
                      21

                      0803
                      OIG HCFAC Discretionary allocation adjustment
                      72
                      67
                      74

                      0899
                      Total reimbursable obligations
                      280
                      298
                      325

                      0900
                      Total new obligations, unexpired accounts
                      356
                      374
                      393

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      32
                      36
                      26

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      2
                      2

                      1050
                      Unobligated balance (total)
                      34
                      38
                      26

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      75
                      75
                      68

                      1121
                      Appropriations transferred from other acct [075–9911]
                      2
                      1

                      1160
                      Appropriation, discretionary (total)
                      77
                      76
                      68

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      68
                      74
                      80

                      1701
                      Change in uncollected payments, Federal sources
                      13
                      14
                      15

                      1750
                      Spending auth from offsetting collections, disc (total)
                      81
                      88
                      95

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      179
                      197
                      216

                      1801
                      Change in uncollected payments, Federal sources
                      21

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      200
                      198
                      216

                      1900
                      Budget authority (total)
                      358
                      362
                      379

                      1930
                      Total budgetary resources available
                      392
                      400
                      405

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      36
                      26
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      52
                      67
                      61

                      3010
                      New obligations, unexpired accounts
                      356
                      374
                      393

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1

                      3020
                      Outlays (gross)
                      –338
                      –378
                      –380

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2
                      –2

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      67
                      61
                      74

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –106
                      –130
                      –144

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –34
                      –14
                      –15

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      10

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –130
                      –144
                      –159

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –54
                      –63
                      –83

                      3200
                      Obligated balance, end of year
                      –63
                      –83
                      –85

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      158
                      164
                      163

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      134
                      149
                      148

                      4011
                      Outlays from discretionary balances
                      20
                      17
                      19

                      4020
                      Outlays, gross (total)
                      154
                      166
                      167

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –77
                      –74
                      –80

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –13
                      –14
                      –15

                      4052
                      Offsetting collections credited to expired accounts
                      9

                      4060
                      Additional offsets against budget authority only (total)
                      –4
                      –14
                      –15

                      4070
                      Budget authority, net (discretionary)
                      77
                      76
                      68

                      4080
                      Outlays, net (discretionary)
                      77
                      92
                      87

                      Mandatory:

                      4090
                      Budget authority, gross
                      200
                      198
                      216

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      135
                      180
                      197

                      4101
                      Outlays from mandatory balances
                      49
                      32
                      16

                      4110
                      Outlays, gross (total)
                      184
                      212
                      213

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –167
                      –185
                      –204

                      4123
                      Non-Federal sources
                      –12
                      –12
                      –12

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –179
                      –197
                      –216

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –21

                      4160
                      Budget authority, net (mandatory)

                      1

                      4170
                      Outlays, net (mandatory)
                      5
                      15
                      –3

                      4180
                      Budget authority, net (total)
                      77
                      77
                      68

                      4190
                      Outlays, net (total)
                      82
                      107
                      84

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      1
                      1

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      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 075–0128–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      38
                      39
                      37

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      39
                      40
                      38

                      12.1
                      Civilian personnel benefits
                      15
                      15
                      14

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      2

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      5
                      5
                      5

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      3
                      3
                      1

                      25.3
                      Other goods and services from Federal sources
                      8
                      6
                      4

                      25.6
                      Medical care

                      1
                      1

                      31.0
                      Equipment
                      3
                      3
                      1

                      99.0
                      Direct obligations
                      76
                      76
                      68

                      99.0
                      Reimbursable obligations
                      280
                      298
                      325

                      99.9
                      Total new obligations, unexpired accounts
                      356
                      374
                      393

          Employment Summary

                      Identification code 075–0128–0–1–551
                      2016 actual
                      2017 est.
                      2018 est.

                      1001
                      Direct civilian full-time equivalent employment
                      346
                      345
                      315

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,229
                      1,245
                      1,362

             General and Administrative Provisions

             GENERAL FUND RECEIPT ACCOUNTS

             (in millions of dollars)

                      2016 actual
                      2017 est.
                      2018 est.

                      Offsetting receipts from the public:

                      075–143500
                      General Fund Proprietary Interest Receipts, not Otherwise Classified
                      148
                      90
                      90

                      075–267403
                      Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                      3
                      127

                      075–275830
                      Downward Reestimates of Subsidies, Health Centers

                      1

                      075–310700
                      Federal Share of Child Support Collections
                      668
                      661
                      642

                      075–310700
                      Legislative proposal, subject to PAYGO

                      6

                      075–322000
                      All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                      164
                      34
                      34

                      General Fund Offsetting receipts from the public
                      983
                      913
                      772

                      Intragovernmental payments:

                      075–388500
                      Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                      67

                      General Fund Intragovernmental payments
                      67

             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 V, except that this section shall not apply to the Head Start program.SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than 2.9 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. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
          which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
          appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
          activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
          of any transfer.SEC. 205. 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 2018 under section 338B of such Act.SEC. 206. 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. 207. 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. 208. 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. 209. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.SEC. 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 2018:
          (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
             Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
             that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
             of 1980 and other applicable statutes administered by the Department of State.

          (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
             to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
             for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
             functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
             and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
             through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
             foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
             of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
             chronic and environmental diseases, and other health activities abroad.

          (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
             benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
             4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
             comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
             percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
             official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
             the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
             Service Act of 1980, to individuals serving in the Foreign Service.
          '

          (transfer of funds)SEC. 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. 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. 213. (a) Authority.—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.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
             with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
             technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
             that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
             Act.
          SEC. 214. 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. 215. (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)), if—
          (1) funds are available and obligated—
             (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
             (B) for the estimated costs associated with a necessary termination of the contract; and

          (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
             full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.

          (b) A contract entered into under this section—
             (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
             (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
          SEC. 216. 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 Services—Program
          Management" account, may be used for payments under section 1342(b)(1) of Public Law 111–148 (relating to risk corridors).SEC. 217. Section 229 of division H of Public Law 114–113 shall continue in effect through January 1, 2019. '

          SEC. 218. (a)  In general.—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 which— (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.—The conditions for making an agreement described in subsection (a) are that — (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.—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 the service provided.
          (d)   Limitations on funds.—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.—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, in — (1)   awarding the grant or cooperative agreement; or
             (2)   providing the agreed-on services.

          (f)   No effect on other laws.—This section does not affect other laws about reimbursable agreements. SEC. 219.   There is hereby established in the Treasury of the United States a fund to be known as the "Federal Emergency Response Fund"
                (the Fund). Amounts in the Fund shall be available, in addition to any other amount appropriated for such purposes, to carry
                out titles II, III, and XVII of the PHS Act with respect to domestic preparedness and global health; to prevent, prepare for,
                or respond to a chemical, biological, radiological, or nuclear threat; to prevent, prepare for, or respond to an emerging
                infectious disease; and to purchase or lease, and provide for the insurance of, passenger motor vehicles for official use
                in foreign countries. Amounts in the Fund may only be used for a public health threat or emergency that the Secretary determines
                has significant potential to occur and potential, on occurrence, to affect national security or the health and security of
                United States citizens, domestically or internationally. The Secretary may transfer to the Fund in this fiscal year and hereafter
                such amounts as are necessary from any discretionary amounts (pursuant to the Balanced Budget and Emergency Deficit Control
                Act of 1985) appropriated in this and subsequent Acts, provided that no such appropriation is reduced by more than 1 percent.
                Such transferred amounts shall remain available until expended. When implementing response activities, amounts in the Fund
                may be transferred to other accounts of the Department of Health and Human Services for the purposes provided in this section.
                The Committees on Appropriations of the House of Representatives and the Senate shall be notified promptly of the initiation
                of response activities under this authority and of any transfer made under the authority provided in this section. The Committees
                on Appropriations of the House of Representatives and the Senate shall receive a report not later than 45 days after the end
                of each quarter in a fiscal year on the unobligated balances in the Response Fund and all actual obligations incurred for
                that fiscal year, including obligations by program, project, or activity. The transfer authorities in this section are in
                addition to any other transfer authority otherwise available to the Department of Health and Human Services. Products purchased
                using amounts in the Fund may, at the discretion of the Secretary of Health and Human Services, be deposited in the Strategic
                National Stockpile under section 319F-2 of the PHS Act. SEC. 220.   Funds appropriated in this Act to accounts that received appropriations in the Department of Health and Human Services Appropriations
                Act, 2016, for the administrative expenses of programs or activities that do not receive appropriations from this Act shall
                be available for necessary expenses to carry out closure of such programs or activities. SEC. 221.   Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)), the Secretary shall charge fees upon health
                care facilities or entities in cases where such facilities or entities have been cited for deficiencies during initial certification,
                recertification, or substantiated complaint surveys to cover all or a portion of the costs incurred for conducting substantiated
                complaint surveys and revisit surveys on such health care facilities and entities. Such fees shall be available to supplement
                funding for such surveys and shall be credited to the "Department of Health and Human Services, Centers for Medicare and Medicaid
                Services, Program Management" account, to remain available until expended.