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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
            
         
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
         
      
         Food and Drug Administration                                                                                             
            
         Federal Funds
         Salaries and expensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
            of space rental and related costs pursuant to Public Law 92â313 for programs and activities of the Food and Drug Administration
            which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
            and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
            on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107â188; $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. 379jâ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.â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. 114â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 075â9911â0â1â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
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  1
                  2
                  3
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  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 [075â0128]
                  â2
                  â1
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â33
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  615
                  333
                  
               
               
                  1723
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  
                  â4
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â620
                  â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
                  â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)
                  â4,693
                  â4,643
                  â2,840
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â17
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â92
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,710
                  2,721
                  2,528
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â59
                  â71
                  â38
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â37
                  33
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â71
                  â38
                  â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
                  â28
                  â33
                  
               
               
                  4033
                  Non-Federal sources
                  â2,098
                  â1,908
                  â761
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â2,126
                  â1,941
                  â761
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â33
                  33
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  
                  â4
                  
               
               
                  4123
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â1
                  â4
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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 075â9911â0â1â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 075â9911â0â1â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 075â9911â2â1â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)
                  
                  
                  â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
                  
                  
                  â2,458
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â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 075â9911â2â1â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 075â9911â2â1â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 075â0148â0â1â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)
                  
                  â20
                  â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 075â5629â0â2â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
                  
                  â20
                  â60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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 [075â9911]
                  
                  â20
                  â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 075â4309â0â3â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
                  â1
                  â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)
                  â9
                  â10
                  â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
                  â9
                  â10
                  â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 075â4309â0â3â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 075â4309â0â3â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
                  â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 [075â0140]
                  â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 [015â5606]
                  â5
                  â5
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â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
                  â2
                  â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
                  â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)
                  â9,674
                  â9,730
                  â8,623
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â80
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â124
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,701
                  8,229
                  5,193
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â36
                  â22
                  â22
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  26
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â22
                  â22
                  â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
                  â27
                  â13
                  â8
               
               
                  4033
                  Non-Federal sources
                  â23
                  â18
                  â18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â50
                  â31
                  â26
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â24
                  â19
                  â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 075â0350â0â1â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
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  235999
                  Total guaranteed loan reestimates
                  
                  â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 2015â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 075â0350â0â1â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 075â0350â0â1â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 075â0350â4â1â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 [015â5606]
                  
                  
                  â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)
                  
                  
                  â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 075â0350â4â1â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 075â0350â4â1â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 075â0320â0â1â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
                  â2
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â2
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203, and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process Fund                                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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 [075â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)
                  â2
                  â3
                  â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 109â148,
            to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses resulting from the administration
            to or use by an individual of a covered countermeasure for which a Secretarial Declaration has been issued, pursuant to section
            319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected claims that may arise under the Smallpox
            Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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 075â0343â0â1â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 075â0321â0â1â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
                  
                  â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)
                  â390
                  â394
                  â375
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â0321â0â1â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 075â0321â0â1â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 075â0321â4â1â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)
                  
                  
                  â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 075â0321â4â1â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 075â0321â4â1â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 075â4442â0â3â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 075â4442â0â3â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
                  â6
                  â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
                  â30
                  â10
                  â10
               
               
                  
                  Adjustments:
               
               
                  2263
                  Terminations for default that result in claim payments
                  
                  â1
                  â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 104â299 and Public Law 104â208 authorize Health Resources and Services Administration (HRSA) to guarantee up to
            $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and
            for the construction, renovation, and modernization of medical facilities. The program account for this activity is displayed
            in the Health Resources and Services account (75â0350) as a line in the program and financing schedule.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  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 075â9931â0â3â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 075â9931â0â3â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.â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. 114â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 075â8175â0â7â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
                  â22
                  â23
                  â27
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â253
                  â260
                  â268
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â275
                  â283
                  â295
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â275
                  â283
                  â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 075â8175â0â7â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
                  â1
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  3
                  
                  
               
               
                  1035
                  Unobligated balance of appropriations withdrawn
                  â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)
                  â276
                  â295
                  â295
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
            for vaccine-related injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  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 075â8175â0â7â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 93â638, such individually identifiable health information relating to disabled children
            as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
            U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
            Indian Health Facilities account.
      Note.âA full-year 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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
                  
                  â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
                  â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)
                  â5,031
                  â5,345
                  â5,028
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â131
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  984
                  542
                  282
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â67
                  â98
                  â98
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â98
                  â98
                  â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
                  â231
                  â271
                  â276
               
               
                  4033
                  Non-Federal sources
                  â1,196
                  â1,151
                  â1,174
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,427
                  â1,422
                  â1,450
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â30
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â0390â0â1â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 075â0390â0â1â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 075â0390â4â1â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)
                  
                  
                  â144
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  6
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  144
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  144
               
               
                  
                     
                  
               
            
         
      
      
         This activity supports evidence-based diabetes treatment and prevention services across Indian Country.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â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)
                  â630
                  â756
                  â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.â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. 114â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 075â0391â0â1â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
                  â7
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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)
                  â479
                  â568
                  â556
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  492
                  455
                  355
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â8
                  â8
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â8
                  â8
                  â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
                  â31
                  â56
                  â57
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â31
                  â56
                  â57
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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 075â0391â0â1â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 075â0391â0â1â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 PROVISIONSâINDIAN HEALTH SERVICE                                                                          
            
         
         Administrative provisionsâindian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
            3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
            5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
            and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
            in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
            5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
            Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
            care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
            recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
            providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
            to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
            Law 93â638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
            purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
            by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
            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 106â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.â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. 114â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 075â0943â0â1â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
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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 [075â9915]
                  â3
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0140]
                  â14
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  15
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â9912]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1362]
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  6,660
                  6,284
                  4,972
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  55
               
               
                  1200
                  Appropriation (075â0943 - Chilhood Obesity Demonstration Project)
                  10
                  
                  
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  1
                  2
                  2
               
               
                  1221
                  Appropriations transferred from other acct [075â0116]
                  892
                  891
                  841
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â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
                  â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)
                  â7,426
                  â7,949
                  â7,253
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â40
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â203
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  6,949
                  6,639
                  5,666
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â132
                  â232
                  â232
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â177
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  77
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â232
                  â232
                  â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
                  â199
                  â408
                  â408
               
               
                  4033
                  Non-Federal sources
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â206
                  â408
                  â408
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â177
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  64
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â4
                  â4
                  â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 075â0943â0â1â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 075â0943â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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)
                  â9
                  â9
                  â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 075â0960â0â1â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 075â4553â0â4â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)
                  â529
                  â545
                  â534
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  217
                  204
                  202
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â2
                  â2
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2
                  â2
                  â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
                  â569
                  â532
                  â532
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â40
                  13
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â4553â0â4â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 075â4553â0â4â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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)
                  â79
                  â100
                  â76
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  47
                  28
                  20
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â5
                  â5
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5
                  â5
                  â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
                  â5
                  â6
                  â3
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  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 075â0944â0â1â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 075â0944â0â1â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 075â0946â0â1â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 (WTCâNYC DHSSâCDC)
                  33
                  38
                  42
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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)
                  â293
                  â279
                  â345
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â48
                  â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. 111â347)
            on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC/NIOSH serves as the
            Program Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
            health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
            2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
            Compensation Reauthorization Act of 2015 (P.L. 114â113, Division O, Title III). The amounts included for 2017 and 2018 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  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 075â0946â0â1â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 Instituteâ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.â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. 114â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 075â9915â0â1â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
                  â34
                  â16
                  â16
               
               
                  2134
                  National Institutes of Health
                  
                  10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â34
                  â6
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â34
                  â6
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  11
                  12
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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 [075â0140]
                  47
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  4
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â5736]
                  13
                  13
                  13
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  
                  â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
                  â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)
                  â33,453
                  â35,664
                  â33,667
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â131
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â979
                  â1,207
                  â1,207
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â540
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  312
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,207
                  â1,207
                  â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
                  â4,013
                  â3,559
                  â3,559
               
               
                  4033
                  Non-Federal sources
                  â157
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,170
                  â3,559
                  â3,559
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â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 075â9915â0â1â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 075â9915â0â1â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 075â9915â4â1â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)
                  
                  
                  â36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  114
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  114
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  36
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  36
               
               
                  
                     
                  
               
            
         
      
         Payment to the NIH Innovation Account, CURES Act                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0147â0â1â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)
                  
                  â352
                  â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 075â5628â0â2â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
                  
                  â352
                  â496
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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 [075â9915]
                  
                  â300
                  â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)
                  
                  â12
                  â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 075â5736â0â2â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
                  â13
                  â13
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  13
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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 [075â9915]
                  â13
                  â13
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Substance Abuse and Mental Health Services Administration                                                                
            
         Federal Funds
         MENTAL HEALTHFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
            Individuals with Mental Illness Act, $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 113â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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 [075â0943]
                  â4
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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 [075â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)
                  â3,575
                  â3,922
                  â3,925
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â88
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3,977
                  4,462
                  4,545
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â126
                  â245
                  â245
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â197
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  78
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â245
                  â245
                  â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
                  â131
                  â248
                  â235
               
               
                  4033
                  Non-Federal sources
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â132
                  â250
                  â237
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â197
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  79
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â1362â0â1â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 075â1362â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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)
                  â349
                  â326
                  â288
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  382
                  411
                  123
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â156
                  â85
                  â85
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â20
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  91
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â85
                  â85
                  â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
                  â80
                  â26
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â80
                  â26
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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 075â1700â0â1â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 075â1700â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â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)
                  â369,061
                  â379,399
                  â408,599
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  
                  â105
                  â105
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â105
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â105
                  â105
                  â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
                  â767
                  â944
                  â1,029
               
               
                  4123
                  Non-Federal sources
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â781
                  â944
                  â1,029
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â105
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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
                  
                  
                  â3,857
               
               
                  
                  Outlays
                  
                  
                  â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 075â0512â0â1â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 075â0512â4â1â551
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  
                  â3,857
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â3,857
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â3,857
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â3,857
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â3,857
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â3,857
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â3,857
               
               
                  3020
                  Outlays (gross)
                  
                  
                  3,857
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â3,857
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â3,857
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â3,857
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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 075â0516â0â1â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
                  â38
                  â6
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â168
                  â464
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  391
                  â386
                  86
               
               
                  1900
                  Budget authority (total)
                  391
                  â386
                  86
               
               
                  1930
                  Total budgetary resources available
                  2,646
                  621
                  574
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â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)
                  â559
                  â537
                  â534
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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
                  â12
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  391
                  â386
                  86
               
               
                  4170
                  Outlays, net (mandatory)
                  547
                  537
                  534
               
               
                  4180
                  Budget authority, net (total)
                  391
                  â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. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â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 075â0516â0â1â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 97â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â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)
                  â319,843
                  â335,075
                  â351,776
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â72
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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
                  
                  
                  â72
               
               
                  
                  Outlays
                  
                  
                  â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 075â0580â0â1â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 075â0580â2â1â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â72
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  
                  â72
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â72
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â72
               
               
                  3020
                  Outlays (gross)
                  
                  
                  72
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â72
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â72
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â72
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â72
               
               
                  
                     
                  
               
            
         
      
         Quality Improvement Organizations                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â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
                  â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)
                  â776
                  â556
                  â806
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â61
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,519
                  1,519
                  1,519
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2,431
                  â2,488
                  â2,488
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â922
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  865
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â2,488
                  â2,488
                  â2,488
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â943
                  â969
                  â969
               
               
                  3200
                  Obligated balance, end of year
                  â969
                  â969
                  â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
                  â682
                  â556
                  â806
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â922
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  644
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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 075â0519â0â1â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 075â0519â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â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
                  â1,091
                  â5,574
                  â11,967
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  52
                  â517
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  32
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  â996
                  â6,091
                  â11,967
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  68
                  3
                  3
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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
                  â94
                  â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
                  â186
                  â6,088
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â43
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  â5,574
                  â11,967
                  â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)
                  â5,948
                  â6,426
                  â6,117
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â32
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â186
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12,072
                  17,944
                  17,706
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5,011
                  â5,470
                  â5,470
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,846
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,387
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â5,470
                  â5,470
                  â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
                  â4,252
                  â4,071
                  â3,691
               
               
                  4033
                  Non-Federal sources
                  â378
                  â8
                  â34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,630
                  â4,079
                  â3,725
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,172
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,239
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  67
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â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
                  â222
                  â240
                  â189
               
               
                  4123
                  Non-Federal sources
                  â1,372
                  â1,622
                  â1,863
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â1,594
                  â1,862
                  â2,052
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â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)
                  â660
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  44
                  â36
                  102
               
               
                  4170
                  Outlays, net (mandatory)
                  29
                  485
                  340
               
               
                  4180
                  Budget authority, net (total)
                  44
                  â36
                  102
               
               
                  4190
                  Outlays, net (total)
                  â276
                  485
                  340
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  130
                  148
                  187
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â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 075â0511â0â1â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 075â0511â0â1â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 075â0511â4â1â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)
                  
                  
                  â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
                  
                  
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â0â1â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 [075â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 [075â5551]
                  
                  â570
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310
                  
                  â542
                  â3,279
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced, Perf. Bonus Pmts.
                  
                  â5,669
                  â1,193
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total):
                  
                  â6,781
                  â4,472
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  19,320
                  20,400
                  5,700
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  2,618
                  570
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â4,679
                  â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
                  â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)
                  â14,305
                  â16,655
                  â12,017
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  â6,781
                  â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. 111â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. 111â148) extended funding
            for CHIP, providing appropriations through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L.
            114â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 075â0515â4â1â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)
                  
                  
                  â1,400
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â1,400
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â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 075â0522â0â1â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)
                  â1,156
                  â1,294
                  â1,408
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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 075â0522â0â1â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 075â0522â0â1â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 075â5551â0â2â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
                  â20
                  
                  
               
               
                  2103
                  Child Enrollment Contingency Fund
                  
                  â2,048
                  â570
               
               
                  2132
                  Child Enrollment Contingency Fund
                  2,048
                  
                  
               
               
                  2134
                  Child Enrollment Contingency Fund
                  
                  570
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  2,028
                  â1,478
                  â570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  2,028
                  â1,478
                  â570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  2,048
                  577
                  7
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â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 [075â0515]
                  
                  â3,656
                  â570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  2,048
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Delay of transfer to other acct [075â0515]
                  
                  570
                  
               
               
                  1134
                  Appropriations precluded from obligation
                  
                  â570
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3,860
                  1,140
                  
               
               
                  1201
                  Appropriation (special or trust fund)
                  20
                  
                  
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  2,048
                  570
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  
                  â2,618
                  â570
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â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)
                  â53
                  â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. 111â3, CHIPRA) established the Child Enrollment
            Contingency Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund
            payment if it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target
            average number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) extended
            the Contingency Fund through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â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 075â0508â0â1â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)
                  â2,765
                  â922
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  80
                  80
                  80
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â227
                  â246
                  â246
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â246
                  â246
                  â246
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â176
                  â166
                  â166
               
               
                  3200
                  Obligated balance, end of year
                  â166
                  â166
                  â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
                  â2,775
                  â922
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â19
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â10
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â0112â0â1â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)
                  â29
                  â28
                  â26
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â5
                  â25
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 111â148) amended Section 2794 of the Public Health Service Act and provided
            that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
            program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
            2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
            insurance reform activities consistent with Section 2794 (c)(2)(B).
         
      
         Pre-Existing Condition Insurance Plan Program                                                                            
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â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)
                  
                  â82
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â217
                  â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.
            111â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 075â0114â0â1â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)
                  
                  â6
                  â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. 111â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 075â0115â0â1â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
                  â2
                  â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)
                  â446
                  â287
                  â59
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 111â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 075â0115â0â1â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 075â0115â0â1â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 075â5733â0â2â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
                  â3,618
                  â4,807
                  â6,361
               
               
                  2103
                  Risk Adjustment Program Payments
                  â174
                  â247
                  â332
               
               
                  2132
                  Risk Adjustment Program Payments
                  247
                  332
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â3,545
                  â4,722
                  â6,693
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â3,545
                  â4,722
                  â6,693
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  248
                  332
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â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
                  â247
                  â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)
                  â2,740
                  â4,737
                  â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. 111â148) established a permanent risk adjustment program
            for non-grandfathered plans in the individual and small group markets. Charges are collected from health insurance issuers
            that enroll healthier than average enrollees and payments are made to issuers that enroll sicker than average enrollees. Risk
            adjustment may be operated by a State, or by the Federal government in the event a State chooses not to operate risk adjustment.
            Payments and charges are made in the year following the plan year for which they are calculated. 
         
      
         Transitional Reinsurance Program                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â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
                  â6,713
                  â3,978
                  â166
               
               
                  2103
                  Transitional Reinsurance Program
                  â650
                  â456
                  â274
               
               
                  2132
                  Transitional Reinsurance Program
                  456
                  274
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â6,907
                  â4,160
                  â440
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â6,907
                  â4,160
                  â440
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  455
                  273
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â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
                  â456
                  â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)
                  â7,623
                  â4,383
                  â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. 111â148) established a transitional, temporary, three-year
            reinsurance program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015,
            and 2016. The Centers for Medicare & Medicaid Services assesses contributing entities a per enrollee fee to fund the reinsurance
            program, and makes payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold,
            up to a reinsurance cap. Reinsurance collections and payments are made in the year following the plan year for which they
            are applicable. Reinsurance collections and payments 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 075â5735â0â2â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 075â0524â0â1â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)
                  â148
                  â32
                  â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 075â0524â0â1â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
                  â8
                  
               
               
                  135002
                  Solvency Loans
                  88
                  5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  92
                  â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.
            112â240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
            loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  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 075â0118â0â1â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 075â0118â0â1â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)
                  â577
                  â82
                  â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 075â0118â0â1â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
                  â65
                  
               
               
                  135003
                  Solvency  Loans
                  416
                  38
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  473
                  â27
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  5
                  
                  1
               
               
                  
                     
                  
               
            
         
      
      
         Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated funding for the
            Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
            insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
            markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves
            which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of
            encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section
            1322.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  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 075â0118â0â1â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 075â4418â0â3â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
                  
                  â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
                  â96
                  â1
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â7
                  â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)
                  â248
                  â143
                  â33
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4
                  1
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â97
                  â1
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  96
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â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
                  â572
                  â82
                  
               
               
                  4122
                  Interest on uninvested funds
                  â12
                  â12
                  â12
               
               
                  4123
                  Non-Federal sources
                  â45
                  â54
                  â98
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â629
                  â148
                  â110
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  96
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  16
                  â7
                  â77
               
               
                  4170
                  Outlays, net (mandatory)
                  â381
                  â5
                  â77
               
               
                  4180
                  Budget authority, net (total)
                  16
                  â7
                  â77
               
               
                  4190
                  Outlays, net (total)
                  â381
                  â5
                  â77
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â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
                  â45
                  â54
                  â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 075â4418â0â3â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 (-)
                  â813
                  â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 075â4482â0â3â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
                  
                  â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
                  â48
                  â14
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â2
                  â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)
                  â121
                  â60
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  33
                  2
                  2
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â62
                  â14
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  48
                  14
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â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
                  â141
                  â30
                  
               
               
                  4122
                  Interest on uninvested funds
                  â3
                  â4
                  â3
               
               
                  4123
                  Non-Federal sources
                  â8
                  â7
                  â14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â152
                  â41
                  â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
                  â9
               
               
                  4170
                  Outlays, net (mandatory)
                  â31
                  19
                  â8
               
               
                  4180
                  Budget authority, net (total)
                  4
                  2
                  â9
               
               
                  4190
                  Outlays, net (total)
                  â31
                  19
                  â8
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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
                  â7
                  â7
                  â14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  451
                  475
                  461
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â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 (-)
                  â153
                  â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 075â8005â0â7â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
                  â2,278
                  â2,362
                  â2,204
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â291,219
                  â303,011
                  â319,072
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â681
                  â681
                  â751
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,329
                  â1,293
                  â1,062
               
               
                  2103
                  Federal Hospital Insurance Trust Fund
                  â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
                  â298,804
                  â298,801
                  â303,445
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â79
               
               
                  2203
                  Federal Hospital Insurance Trust Fund
                  
                  
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  
                  â53
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â298,804
                  â298,801
                  â303,498
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  158,585
                  166,974
                  186,980
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â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
                  
                  â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)
                  â7
                  
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  â8,496
                  â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)
                  â297,204
                  â297,776
                  â302,481
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 075â8005â0â7â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 [009â38â8005â0]
                  â297,204
                  â297,776
                  â302,481
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [009â38â8393â0]
                  â1,727
                  â2,764
                  â1,988
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â298,931
                  â300,540
                  â304,469
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Hospital Insurance Trust Fund
                  
                  
                  â43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  â43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â298,931
                  â300,540
                  â304,512
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  â11,593
                  â763
                  11,190
               
               
                  3120
                  Interest
                  8,045
                  7,413
                  7,802
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â3,548
                  6,650
                  18,992
               
               
                  3220
                  Federal Hospital Insurance Trust Fund
                  
                  â9
                  
               
               
                  3298
                  Rounding adjustment
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  2
                  â9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  â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 075â8005â0â7â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 075â8005â0â7â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 075â8005â4â7â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â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)
                  
                  
                  â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)
                  
                  
                  â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 075â8005â4â7â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â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
                  
                  â27
                  â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
                  â50
                  â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
                  â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)
                  â1,727
                  â2,764
                  â1,988
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
            in the Analytical Perspectives volume.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  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
                  
                  â27
                  â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 075â8393â0â7â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 075â8004â0â7â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
                  
                  
                  â21
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â3
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  
                  
                  â72
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  
                  â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
                  â2,959
                  â3,085
                  â2,881
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â300,593
                  â316,225
                  â352,198
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â687
                  â699
                  â644
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â89,106
                  â95,128
                  â86,013
               
               
                  2134
                  Federal Supplementary Medical Insurance Trust Fund
                  283
                  4,467
                  27,519
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â393,062
                  â410,670
                  â414,217
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  72
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â42
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â72
               
               
                  2234
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  58
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â393,062
                  â410,670
                  â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 075â8004â0â7â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
                  
                  â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
                  â283
                  â4,467
                  â27,519
               
               
                  1236
                  Appropriations applied to repay debt
                  â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)
                  â304,021
                  â314,393
                  â327,176
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  25,829
                  26,270
                  26,657
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â11,172
                  
                  
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  11,172
                  
                  
               
               
                  
                  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
                  â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
                  
                  â3,288
                  â3,288
               
               
                  5081
                  Outstanding debt, EOY
                  â3,288
                  â3,288
                  â3,288
               
               
                  5082
                  Borrowing
                  â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
                  
                  
                  â16
               
               
                  
                  Outlays
                  
                  
                  â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 075â8004â0â7â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
                  
                  
                  â21
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â3
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  Federal Contributions, FSMI Fund
                  
                  
                  â72
               
               
                  1260
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  
                  â96
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  393,378
                  415,131
                  441,667
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Supplementary Medical Insurance Trust Fund [009â38â8004â0]
                  â304,021
                  â314,393
                  â327,176
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009â38â8308â0]
                  â95,705
                  â95,575
                  â86,432
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â399,726
                  â409,968
                  â413,608
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  
                  26
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â399,726
                  â409,968
                  â413,582
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  â8,378
                  3,622
                  27,038
               
               
                  3120
                  Interest
                  2,030
                  1,541
                  1,047
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  â6,348
                  5,163
                  28,085
               
               
                  3220
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  â6,348
                  5,157
                  28,085
               
               
                  
                  Unexpended balance, end of year::
               
               
                  4100
                  Uninvested balance (net), end of year
                  â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 075â8004â0â7â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 075â8004â0â7â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 075â8004â2â7â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â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 075â8004â4â7â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â96
               
               
                  0004
                  Administration, SMI
                  
                  
                  80
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â16
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  42
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â58
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â16
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â16
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â16
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â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
                  
                  
                  â16
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â26
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â16
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â26
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â4â7â571
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  
                  â96
               
               
                  94.0
                  Financial transfers
                  
                  
                  80
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â16
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â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
                  â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)
                  â95,705
                  â95,575
                  â86,432
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  14,638
                  14,887
                  15,110
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â14,109
                  â14,109
               
               
                  3061
                  Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                  â11,172
                  
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,937
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â14,109
                  â14,109
                  â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
                  â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
                  â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 075â8308â0â7â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 075â8308â0â7â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 075â1552â0â1â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
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,737
                  16,737
                  16,739
               
               
                  1930
                  Total budgetary resources available
                  16,737
                  16,737
                  16,741
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â15
                  â15
                  â15
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  2
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  5,940
                  7,037
                  7,253
               
               
                  3010
                  New obligations, unexpired accounts
                  16,722
                  16,720
                  16,722
               
               
                  3020
                  Outlays (gross)
                  â15,624
                  â16,504
                  â16,628
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â1,268
               
               
                  
                  Outlays
                  
                  
                  â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. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171). Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently
            in the Further Continuing and Security Assistance Appropriations Act, 2017 (P.L. 114â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 075â1552â0â1â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 075â1552â0â1â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 075â1552â4â1â609
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  
                  
                  â1,262
               
               
                  0002
                  Territories - family assistance grants
                  
                  
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â1,268
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,243
               
               
                  1220
                  Appropriations transferred to other acct [013â0401]
                  
                  
                  â10
               
               
                  1220
                  Appropriations transferred to other acct [075â1553]
                  
                  
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  
                  â1,268
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,268
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,268
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,243
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â25
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â25
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,268
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,243
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,268
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,243
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â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 [075â1553]
                  
                  â15
                  
               
               
                  1120
                  Appropriations transferred to other acct [013â0401]
                  
                  â10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  â25
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  608
                  608
                  608
               
               
                  1220
                  Appropriations transferred to other accts [075â1553]
                  â15
                  
                  
               
               
                  1220
                  Appropriations transferred to other accts [013â0401]
                  â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)
                  â572
                  â594
                  â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
                  
                  â25
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â22
                  
               
               
                  4011
                  Outlays from discretionary balances
                  
                  
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  
                  â22
                  â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
                  
                  
                  â608
               
               
                  
                  Outlays
                  
                  
                  â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 075â1522â4â1â609
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  
                  
                  â608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â608
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â608
               
               
                  3020
                  Outlays (gross)
                  
                  
                  567
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â41
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â41
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â567
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â608
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â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. 321â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. 321â329), for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal year, such sums
            as may be necessary.
      Note.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â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)
                  â4,094
                  â4,278
                  â4,425
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â227
                  â200
                  â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
                  â15
                  â12
                  â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
                  
                  
                  â110
               
               
                  
                  Outlays
                  
                  
                  â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 075â1501â0â1â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 075â1501â4â1â609
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  
                  
                  â110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  
                  
                  â110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  â110
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â110
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â110
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â110
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â110
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â110
               
               
                  3020
                  Outlays (gross)
                  
                  
                  110
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â110
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â110
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â110
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â110
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Low income home energy assistance
      Note.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â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 [075â0140]
                  â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)
                  â3,262
                  â3,101
                  â1,113
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â1502â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â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 [075â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
                  â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)
                  â1,632
                  â2,376
                  â1,451
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â1503â0â1â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 075â1503â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â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
                  â23
                  â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
                  â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)
                  â479
                  â524
                  â509
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  â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 075â1512â0â1â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 075â1512â0â1â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 075â1512â4â1â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)
                  
                  
                  â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 075â1512â4â1â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 075â1512â4â1â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 075â1550â0â1â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)
                  â2,788
                  â2,968
                  â2,946
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Further Continuing and
            Security Assistance Appropriations Act, 2017 (P.L. 114â254). 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â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)
                  â2,518
                  â2,725
                  â2,772
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â1515â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â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
                  â116
                  â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
                  â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)
                  â1,780
                  â1,699
                  â1,770
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  
                  
                  â1,615
               
               
                  
                  Outlays
                  
                  
                  â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 075â1534â0â1â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 075â1534â0â1â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 075â1534â4â1â506
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Health Profession Opportunity Grants
                  
                  
                  85
               
               
                  0003
                  Social Services Block Grant
                  
                  
                  â1,700
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,615
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â1,615
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,408
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â207
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â207
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,615
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,408
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,615
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,408
               
               
                  
                     
                  
               
            
         
      
      
          
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â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
                  
                  
                  â1,627
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â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
                  â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)
                  â10,402
                  â11,664
                  â10,902
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â65
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,620
                  6,939
                  6,261
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â9
                  â14
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â6
                  â5
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â9
                  â14
                  â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
                  â7
                  â18
                  â18
               
               
                  4033
                  Non-Federal sources
                  
                  â2
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â7
                  â20
                  â24
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â5
                  â4
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â4
                  â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
                  â2
                  â1
                  â1
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  â1
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  
                  â1
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  1
                  â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 075â1536â0â1â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 075â1536â0â1â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 075â1553â0â1â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 [075â1522]
                  
                  15
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  37
                  37
                  37
               
               
                  1200
                  Appropriation [Pop-up]
                  
                  1
                  1
               
               
                  1221
                  Appropriations transferred from other acct [075â1522]
                  15
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3
                  â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
                  â1
                  â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)
                  â102
                  â80
                  â74
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â6
                  â1
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  43
                  52
                  41
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â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
                  â7
                  â7
                  â7
               
               
                  4123
                  Non-Federal sources
                  â17
                  â19
                  â19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â24
                  â26
                  â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. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            For fiscal years 2010â2014, Welfare Research had been temporarily reauthorized; for FY 2015 and FY 2016, annual appropriations
            provided funds for Welfare Research via a transfer from the TANF Contingency Fund. The Budget includes a 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 075â1553â0â1â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 075â1553â0â1â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 075â1553â4â1â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 [075â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)
                  
                  
                  â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 075â1553â4â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â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
                  â2
                  â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)
                  â7,700
                  â8,025
                  â8,439
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 Careâ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 Assistanceâ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 ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 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 075â1545â0â1â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 075â1545â0â1â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 075â1545â4â1â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)
                  
                  
                  â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â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 [012â3507]
                  â2
                  
                  
               
               
                  1120
                  Appropriations transferred to other accts [075â0140]
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,908
                  1,909
                  1,851
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â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
                  â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)
                  â2,009
                  â2,080
                  â1,998
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,261
                  1,211
                  1,107
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â105
                  â163
                  â163
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â76
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â163
                  â163
                  â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
                  â23
                  â62
                  â18
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â57
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â14
                  â62
                  â25
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â19
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â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
                  
                  
                  â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 075â0142â0â1â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 075â0142â0â1â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 075â0142â4â1â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)
                  
                  
                  â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
                  
                  
                  â25
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â20
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â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 075â0142â4â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â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 [075â0943]
                  â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
                  â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)
                  â677
                  â741
                  â679
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â45
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  517
                  504
                  400
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â220
                  â230
                  â230
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â144
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  134
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â230
                  â230
                  â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
                  â217
                  â273
                  â270
               
               
                  4033
                  Non-Federal sources:
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â220
                  â273
                  â270
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â136
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  128
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â6
                  â13
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â8
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â7
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  8
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  455
                  455
                  305
               
               
                  4190
                  Outlays, net (total)
                  451
                  455
                  394
               
               
                  
                     
                  
               
            
         
      
      
         Note.â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 075â9912â0â1â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 075â9912â0â1â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 075â9912â4â1â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)
                  
                  
                  â2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  2
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         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 075â9912â4â1â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 075â9912â4â1â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 075â0146â0â1â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)
                  
                  â500
                  â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 075â5627â0â2â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
                  
                  â500
                  â500
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5627â0â2â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 [075â1362]
                  
                  â500
                  â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â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
                  â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
                  â1
                  â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)
                  â42
                  â50
                  â43
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12
                  15
                  16
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  
                  â1
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â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
                  
                  â1
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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
                  â26
                  â8
                  â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 075â0135â0â1â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 075â0135â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â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)
                  â105
                  â148
                  â58
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  95
                  27
                  22
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â30
                  â26
                  â26
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â26
                  â26
                  â26
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  91
                  69
                  1
               
               
                  3200
                  Obligated balance, end of year
                  69
                  1
                  â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
                  â20
                  â20
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â20
                  â20
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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. 111â5, Title XIII), for the purpose of addressing
            strategic planning, coordination, and the analysis of key technical, economic and other issues related to the public and private
            adoption of health information technology.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  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 075â0130â0â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â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
                  â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)
                  â94
                  â135
                  â117
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  29
                  1
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â26
                  â42
                  â42
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â36
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â42
                  â42
                  â42
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â7
                  â13
                  â41
               
               
                  3200
                  Obligated balance, end of year
                  â13
                  â41
                  â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
                  â91
                  â107
                  â117
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â36
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  20
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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 075â0139â0â1â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 075â0139â0â1â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 075â0139â4â1â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)
                  
                  
                  â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
                  
                  
                  â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 075â0139â4â1â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 075â0139â4â1â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â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 [075â0343]
                  â2
                  â3
                  â3
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0943]
                  â15
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0943]
                  â10
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â4
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â47
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â1502]
                  19
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0350]
                  7
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â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)
                  â1,537
                  â2,874
                  â1,818
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â15
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,269
                  3,480
                  3,395
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â83
                  â81
                  â81
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â17
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  19
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â81
                  â81
                  â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
                  â12
                  â82
                  â82
               
               
                  4033
                  Non-Federal sources
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â21
                  â82
                  â82
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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 075â0140â0â1â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 075â0140â0â1â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 075â0145â0â1â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)
                  â96
                  â70
                  â87
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â117
                  â116
                  â133
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â21
                  â46
                  â46
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
            20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and
            Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
            from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
            and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research.
            Transferred funds 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 075â0145â0â1â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 075â0145â0â1â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 075â0125â0â1â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 [075â1503]
                  
                  â300
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  
                  â100
                  â560
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total):
                  
                  â400
                  â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)
                  â404
                  â376
                  530
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  
                  â400
                  â560
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  â100
                  â560
               
               
                  4011
                  Outlays from discretionary balances
                  404
                  476
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  404
                  376
                  â530
               
               
                  4180
                  Budget authority, net (total)
                  
                  â400
                  â560
               
               
                  4190
                  Outlays, net (total)
                  404
                  376
                  â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 075â0125â0â1â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 075â0125â0â1â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 075â0119â0â1â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)
                  â14
                  â18
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â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 [075â0142]
                  â28
                  â28
                  
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â892
                  â891
                  â841
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  â12
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â68
                  â69
                  â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 075â0117â0â1â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
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  23
                  23
                  25
               
               
                  1930
                  Total budgetary resources available
                  23
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  29
                  27
                  24
               
               
                  3010
                  New obligations, unexpired accounts
                  23
                  23
                  25
               
               
                  3020
                  Outlays (gross)
                  â25
                  â26
                  â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 075â0117â0â1â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 075â0117â0â1â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 075â3902â0â1â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)
                  â309
                  â1,100
                  â659
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  906
                  279
                  45
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â739
                  â923
                  â923
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â382
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  198
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â923
                  â923
                  â923
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â1
                  â17
                  â644
               
               
                  3200
                  Obligated balance, end of year
                  â17
                  â644
                  â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
                  â293
                  â473
                  â425
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â293
                  â473
                  â425
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â382
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  202
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â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
                  â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)
                  â592
                  â594
                  â649
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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 075â0379â0â1â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 075â0170â0â1â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)
                  â26
                  â28
                  â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
                  
                  
                  â1
               
               
                  
                  Outlays
                  
                  
                  â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. 108â375, section 725).
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0170â2â1â551
                  2016 actual
                  2017 est.
                  2018 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  
                  
                  â1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  
                  
                  â1
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â1
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  
                  â1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9913â0â1â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 075â9941â0â4â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)
                  â1,151
                  â2,132
                  â1,251
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â84
                  â45
                  â181
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  909
                  209
                  173
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â428
                  â460
                  â460
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â460
                  â460
                  â460
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  363
                  449
                  â251
               
               
                  3200
                  Obligated balance, end of year
                  449
                  â251
                  â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
                  â1,295
                  â1,268
                  â1,251
               
               
                  4033
                  Non-Federal sources
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,303
                  â1,268
                  â1,251
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â32
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â152
                  864
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â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 075â9941â0â4â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 075â9941â0â4â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 075â9971â0â7â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
                  â84
                  â85
                  â84
               
               
                  2103
                  Miscellaneous Trust Funds
                  
                  â3
                  â3
               
               
                  2132
                  Miscellaneous Trust Funds
                  
                  3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â84
                  â85
                  â87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â84
                  â85
                  â87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  10
                  18
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â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
                  
                  â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)
                  â141
                  â143
                  â141
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  â8
                  â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
                  â61
                  â61
                  â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 075â9971â0â7â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 075â9971â0â7â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.â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. 114â254). The amounts
         included for 2017 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â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 [075â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
                  â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)
                  â338
                  â378
                  â380
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  â2
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  67
                  61
                  74
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â106
                  â130
                  â144
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â34
                  â14
                  â15
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â130
                  â144
                  â159
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â54
                  â63
                  â83
               
               
                  3200
                  Obligated balance, end of year
                  â63
                  â83
                  â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
                  â77
                  â74
                  â80
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â13
                  â14
                  â15
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â4
                  â14
                  â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
                  â167
                  â185
                  â204
               
               
                  4123
                  Non-Federal sources
                  â12
                  â12
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â179
                  â197
                  â216
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  1
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  5
                  15
                  â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 075â0128â0â1â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 075â0128â0â1â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:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  148
                  90
                  90
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                  3
                  127
                  
               
               
                  075â275830
                  Downward Reestimates of Subsidies, Health Centers
                  
                  1
                  
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  668
                  661
                  642
               
               
                  075â310700
                  Legislative proposal, subject to PAYGO
                  
                  
                  6
               
               
                  075â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:
               
               
                  075â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.âNotwithstanding any other provision of law, the Director of NIH ("Director") may use funds available under section 402(b)(7)
      or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
      out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
      in such section 402(b)(12).
      (b) Peer review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      SEC. 214. 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)), ifâ
      (1) funds are available and obligatedâ
         (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
         (B) for the estimated costs associated with a necessary termination of the contract; and
      
      (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
         full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
      
      (b) A contract entered into under this sectionâ
         (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
         (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
      SEC. 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 ServicesâProgram
      Management" account, may be used for payments under section 1342(b)(1) of Public Law 111â148 (relating to risk corridors).SEC. 217. Section 229 of division H of Public Law 114â113 shall continue in effect through January 1, 2019. '
      			
      SEC. 218. (a)  In general.âUnder the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within
            the Department may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit
            within the Department or of another agency under whichâ (1)   the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
               or cooperative agreement on behalf of the ordering agency or unit; 
      (2)   the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or
               unit; and 
      (3)   the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
               and for the service of executing or managing the grant or cooperative agreement. 
      (b)   Conditions.âThe conditions for making an agreement described in subsection (a) are that â (1)   amounts are available; 
         (2)   the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and 
         (3)   the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service. 
      
      (c)   Payment.âPayment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the
               agency or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for
               any part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a
               request for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance
               shall be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
               and the actual cost of the service provided. 
      (d)   Limitations on funds.âA condition or limitation applicable to amounts for grant or cooperative agreements of the ordering
               agency or unit applies to an agreement made under this section and to a grant or cooperative agreement made under such agreement. 
      (e)   Obligation of appropriations.âAn agreement made under this section obligates an appropriation of the ordering agency or unit.
               The amount obligated is deobligated to the extent that the agency or unit providing the service has not incurred obligations,
               before the end of the period of availability of the appropriation, in â (1)   awarding the grant or cooperative agreement; or 
         (2)   providing the agreed-on services. 
      
      (f)   No effect on other laws.â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.