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

             <h1>DEPARTMENT OF HEALTH AND HUMAN SERVICES

             </h1>

          DEPARTMENT OF HEALTH AND HUMAN SERVICES

             Food and Drug Administration

             Federal Funds
             Salaries and expensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
                of space rental and related costs pursuant to Public Law 92–313 for programs and activities of the Food and Drug Administration
                which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
                and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
                on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107–188; $5,083,474,000: Provided, That of the amount provided under this heading, $960,568,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this
                   account and remain available until expended; $196,668,000 shall be derived from medical device user fees authorized by 21
                   U.S.C. 379j, and shall be credited to this account and remain available until expended; $501,396,000 shall be derived from
                   human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account and remain available until
                   expended; $40,922,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall
                   be credited to this account and remain available until expended; $712,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain
                available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees, medical device user fees, human generic drug user fees, and biosimilar
                   biological product user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited
                   to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device,
                   human generic drug, and biosimilar biological product assessments for fiscal year 2019, including any such fees collected prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified under this heading and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 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, $11,788,000, to remain available until expended.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      1
                      1
                      2

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, FDA
                      2
                      3
                      3

                      2000
                      Total: Balances and receipts
                      3
                      4
                      5

                      Appropriations:

                      Current law:

                      2101
                      Salaries and Expenses
                      –2
                      –2
                      –2

                      5099
                      Balance, end of year
                      1
                      2
                      3

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Foods
                      1,026
                      1,022
                      1,020

                      0002
                      Human Drugs
                      489
                      488
                      461

                      0003
                      Devices and Radiological Health
                      330
                      327
                      323

                      0004
                      National Center for Toxicological Research
                      63
                      63
                      63

                      0005
                      FDA Other Activities (FDA Headquaters)
                      187
                      181
                      122

                      0006
                      FDA Other Rent and Rent Related Activities (Including White Oak Consolidation)
                      115
                      114
                      136

                      0007
                      FDA GSA Rental Payments
                      170
                      169
                      168

                      0008
                      FDA Buildings and Facilities
                      9
                      12
                      12

                      0009
                      Cooperative Research and Development (CRADA)
                      1
                      2
                      2

                      0010
                      Animal Drugs and Feed
                      163
                      162
                      170

                      0011
                      Biologics
                      216
                      214
                      204

                      0012
                      Food and Drug Safety (no-year)
                      2

                      0014
                      Zika Activities
                      3

                      0015
                      CURES Activities

                      20
                      70

                      0016
                      Emerging Health Threats
                      2

                      0799
                      Total direct obligations
                      2,776
                      2,774
                      2,751

                      0801
                      FDA Reimbursable program (User fees)
                      2,312
                      2,345
                      2,460

                      0802
                      FDA Reimbursable program (Federal sources)
                      45

                      0899
                      Total reimbursable obligations
                      2,357
                      2,345
                      2,460

                      0900
                      Total new obligations, unexpired accounts
                      5,133
                      5,119
                      5,211

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,117
                      927
                      919

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1,117
                      927

                      1021
                      Recoveries of prior year unpaid obligations
                      57

                      1050
                      Unobligated balance (total)
                      1,174
                      927
                      919

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,781
                      2,761
                      2,684

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

                      1120
                      Appropriations transferred to other acct [075–4613]

                      –5

                      1121
                      Appropriations transferred from other acct [075–5629]

                      20
                      70

                      1160
                      Appropriation, discretionary (total)
                      2,779
                      2,780
                      2,749

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      2
                      2
                      2

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,655
                      2,345
                      2,464

                      1700
                      Collected

                      35

                      1701
                      Change in uncollected payments, Federal sources
                      35
                      –35

                      1702
                      Offsetting collections (previously unavailable)
                      611

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

                      –16

                      1725
                      Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                      –197

                      1750
                      Spending auth from offsetting collections, disc (total)
                      2,104
                      2,329
                      2,464

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1

                      1900
                      Budget authority (total)
                      4,886
                      5,111
                      5,215

                      1930
                      Total budgetary resources available
                      6,060
                      6,038
                      6,134

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      927
                      919
                      923

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      2,710
                      2,723
                      2,874

                      3010
                      New obligations, unexpired accounts
                      5,133
                      5,119
                      5,211

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      40

                      3020
                      Outlays (gross)
                      –4,989
                      –4,968
                      –5,242

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –57

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –114

                      3050
                      Unpaid obligations, end of year
                      2,723
                      2,874
                      2,843

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –71
                      –65
                      –30

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –35
                      35

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      41

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –65
                      –30
                      –30

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2,639
                      2,658
                      2,844

                      3200
                      Obligated balance, end of year
                      2,658
                      2,844
                      2,813

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,883
                      5,109
                      5,213

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,795
                      4,079
                      4,214

                      4011
                      Outlays from discretionary balances
                      2,192
                      885
                      1,024

                      4020
                      Outlays, gross (total)
                      4,987
                      4,964
                      5,238

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –31
                      –35

                      4033
                      Non-Federal sources:
                      –1,645
                      –2,345
                      –2,464

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,676
                      –2,380
                      –2,464

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –35
                      35

                      4052
                      Offsetting collections credited to expired accounts
                      21

                      4060
                      Additional offsets against budget authority only (total)
                      –14
                      35

                      4070
                      Budget authority, net (discretionary)
                      3,193
                      2,764
                      2,749

                      4080
                      Outlays, net (discretionary)
                      3,311
                      2,584
                      2,774

                      Mandatory:

                      4090
                      Budget authority, gross
                      3
                      2
                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      2
                      2

                      4101
                      Outlays from mandatory balances
                      2
                      2
                      2

                      4110
                      Outlays, gross (total)
                      2
                      4
                      4

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources:
                      –4

                      4123
                      Non-Federal sources:
                      –1

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –5

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      4

                      4160
                      Budget authority, net (mandatory)
                      2
                      2
                      2

                      4170
                      Outlays, net (mandatory)
                      –3
                      4
                      4

                      4180
                      Budget authority, net (total)
                      3,195
                      2,766
                      2,751

                      4190
                      Outlays, net (total)
                      3,308
                      2,588
                      2,778

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      643
                      229
                      245

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      229
                      245
                      245

             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, safe, and 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 2019 Budget includes $5.3 billion in total resources for FDA. The Budget
                prioritizes resources across core public health activities to support food and medical product safety, including implementation
                of the 21st Century Cures Act and the FDA Reauthorization Act of 2017.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–0–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      939
                      952
                      926

                      11.3
                      Other than full-time permanent
                      89
                      90
                      88

                      11.5
                      Other personnel compensation
                      46
                      47
                      46

                      11.7
                      Military personnel
                      63
                      64
                      66

                      11.8
                      Special personal services payments
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      1,138
                      1,154
                      1,127

                      12.1
                      Civilian personnel benefits
                      350
                      354
                      345

                      12.2
                      Military personnel benefits
                      32
                      32
                      33

                      21.0
                      Travel and transportation of persons
                      49
                      47
                      48

                      22.0
                      Transportation of things
                      3
                      3
                      3

                      23.1
                      Rental payments to GSA
                      170
                      169
                      168

                      23.2
                      Rental payments to others
                      3
                      3
                      3

                      23.3
                      Communications, utilities, and miscellaneous charges
                      22
                      22
                      22

                      24.0
                      Printing and reproduction
                      2
                      2
                      2

                      25.1
                      Advisory and assistance services
                      53
                      51
                      52

                      25.2
                      Other services from non-Federal sources
                      357
                      355
                      356

                      25.3
                      Other goods and services from Federal sources
                      142
                      137
                      139

                      25.4
                      Operation and maintenance of facilities
                      85
                      83
                      85

                      25.5
                      Research and development contracts
                      19
                      19
                      19

                      25.7
                      Operation and maintenance of equipment
                      100
                      97
                      99

                      26.0
                      Supplies and materials
                      51
                      49
                      50

                      31.0
                      Equipment
                      37
                      36
                      36

                      32.0
                      Land and structures
                      3
                      3
                      3

                      41.0
                      Grants, subsidies, and contributions
                      157
                      156
                      159

                      42.0
                      Insurance claims and indemnities
                      2
                      2
                      2

                      99.0
                      Direct obligations
                      2,775
                      2,774
                      2,751

                      99.0
                      Reimbursable obligations
                      2,358
                      2,345
                      2,460

                      99.9
                      Total new obligations, unexpired accounts
                      5,133
                      5,119
                      5,211

          Employment Summary

                      Identification code 075–9911–0–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      9,748
                      9,704
                      9,402

                      1101
                      Direct military average strength employment
                      690
                      690
                      690

                      2001
                      Reimbursable civilian full-time equivalent employment
                      6,167
                      6,777
                      6,739

                      2101
                      Reimbursable military average strength employment
                      437
                      437
                      428

                      3001
                      Allocation account civilian full-time equivalent employment
                      25
                      25
                      25

                      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 animal drug review, animal generic drug review activities, and over-the-counter monograph drug activities: Provided, That fees of $25,129,000, for animal drug reviews, shall be credited to this account and remain available until expended; $13,076,000 for animal generic drug reviews, shall be credited to this account and remain available until expended; $22,000,000 for over-the-counter monograph drug activities, 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, animal generic drug, and over-the-counter monograph drug user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug, animal generic drug, and over-the-counter monograph drug reviews for fiscal year 2019 received during fiscal year 2019, including any such fees assessed prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified in this paragraph and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 shall not be included in amounts in this paragraph.

          Program and Financing (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Reimbursable program (Over-the-Counter Monograph User fees)

                      22

                      0803
                      Reimbursable program activity (ADUFA)

                      25

                      0804
                      Reimbursable program activity (AGDUFA)

                      13

                      0899
                      Total reimbursable obligations

                      60

                      0900
                      Total new obligations, unexpired accounts

                      60

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected

                      60

                      1900
                      Budget authority (total)

                      60

                      1930
                      Total budgetary resources available

                      60

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      60

                      3020
                      Outlays (gross)

                      –60

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      60

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      60

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources:

                      –60

                      4040
                      Offsets against gross budget authority  and outlays (total)

                      –60

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

              The FY 2019 Budget proposes to reauthorize the expiring fee programs and propose a new fee program. The budget includes a
                total of $25 million in animal drug fees and $13 million in animal generic drug fees. FDA also proposes reforms to the Over-the-Counter
                Monograph program and includes a total of $22 million in new over-the-counter drug fees. The proposed legislation authorizes
                the collection and spending of these fees subject to appropriations.

          Object Classification (in millions of dollars)

                      Identification code 075–9911–2–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      12

                      11.3
                      Other than full-time permanent

                      2

                      11.5
                      Other personnel compensation

                      1

                      11.7
                      Military personnel

                      1

                      11.9
                      Total personnel compensation

                      16

                      12.1
                      Civilian personnel benefits

                      5

                      23.1
                      Rental payments to GSA

                      3

                      25.1
                      Advisory and assistance services

                      1

                      25.2
                      Other services from non-Federal sources

                      19

                      25.3
                      Other goods and services from Federal sources

                      11

                      25.5
                      Research and development contracts

                      1

                      25.7
                      Operation and maintenance of equipment

                      1

                      41.0
                      Grants, subsidies, and contributions

                      3

                      99.0
                      Reimbursable obligations

                      60

                      99.9
                      Total new obligations, unexpired accounts

                      60

          Employment Summary

                      Identification code 075–9911–2–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      2001
                      Reimbursable civilian full-time equivalent employment

                      144

                      2101
                      Reimbursable military average strength employment

                      9

             FDA Working Capital Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–4613–0–4–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1121
                      Appropriations transferred from other acct [075–9911]

                      5

                      1930
                      Total budgetary resources available

                      5

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      5

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      5

                      4180
                      Budget authority, net (total)

                      5

                      4190
                      Outlays, net (total)

             Payment to the FDA Innovation Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0148–0–1–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Direct program activity
                      20
                      60
                      70

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      20
                      60
                      70

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      20
                      60
                      70

                      1930
                      Total budgetary resources available
                      20
                      60
                      70

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      20
                      60
                      70

                      3020
                      Outlays (gross)
                      –20
                      –60
                      –70

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      20
                      60
                      70

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      20
                      60
                      70

                      4180
                      Budget authority, net (total)
                      20
                      60
                      70

                      4190
                      Outlays, net (total)
                      20
                      60
                      70

             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", $70,000,000, to remain available until expended: Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act,
                are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the Secretary
                of Health and Human Services to other accounts of the Department solely for the purposes provided in such Act: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      40

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, FDA Innovation, CURES Act
                      20
                      60
                      70

                      2000
                      Total: Balances and receipts
                      20
                      60
                      110

                      Appropriations:

                      Current law:

                      2101
                      FDA Innovation, Cures Act
                      –20
                      –20
                      –70

                      5099
                      Balance, end of year

                      40
                      40

          Program and Financing (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      New Obligations for CURES Activities
                      12

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      8
                      8

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      20
                      20
                      70

                      1120
                      Appropriations transferred to other acct [075–9911]

                      –20
                      –70

                      1160
                      Appropriation, discretionary (total)
                      20

                      1930
                      Total budgetary resources available
                      20
                      8
                      8

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      8
                      8
                      8

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      8

                      3010
                      New obligations, unexpired accounts
                      12

                      3020
                      Outlays (gross)
                      –4
                      –8

                      3050
                      Unpaid obligations, end of year
                      8

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      8

                      3200
                      Obligated balance, end of year
                      8

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      20

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4

                      4011
                      Outlays from discretionary balances

                      8

                      4020
                      Outlays, gross (total)
                      4
                      8

                      4180
                      Budget authority, net (total)
                      20

                      4190
                      Outlays, net (total)
                      4
                      8

             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.

          Object Classification (in millions of dollars)

                      Identification code 075–5629–0–2–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      3

                      12.1
                      Civilian personnel benefits
                      1

                      25.2
                      Other services from non-Federal sources
                      5

                      41.0
                      Grants, subsidies, and contributions
                      3

                      99.9
                      Total new obligations, unexpired accounts
                      12

          Employment Summary

                      Identification code 075–5629–0–2–554
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      26

             Revolving Fund for Certification and Other Services

             Program and Financing (in millions of dollars)

                      Identification code 075–4309–0–3–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

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

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      5
                      4
                      4

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      9
                      10
                      9

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

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

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

                      1900
                      Budget authority (total)
                      9
                      10
                      10

                      1930
                      Total budgetary resources available
                      14
                      14
                      14

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      4
                      4
                      4

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3
                      4

                      3010
                      New obligations, unexpired accounts
                      10
                      10
                      10

                      3020
                      Outlays (gross)
                      –9
                      –14
                      –9

                      3050
                      Unpaid obligations, end of year
                      4

                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3
                      4

                      3200
                      Obligated balance, end of year
                      4

                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      9
                      10
                      10

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      4
                      10
                      9

                      4101
                      Outlays from mandatory balances
                      5
                      4

                      4110
                      Outlays, gross (total)
                      9
                      14
                      9

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –9
                      –10
                      –9

                      4180
                      Budget authority, net (total)

                      1

                      4190
                      Outlays, net (total)

                      4

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1

             FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs,
                medical devices, and cosmetics. These services are financed wholly by fees paid by the industries affected.

          Object Classification (in millions of dollars)

                      Identification code 075–4309–0–3–554
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      5
                      5
                      5

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      1
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      10
                      10
                      10

          Employment Summary

                      Identification code 075–4309–0–3–554
                      2017 actual
                      2018 est.
                      2019 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      40
                      37
                      37

             Health Resources and Services Administration

             Federal Funds
             Primary health careFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
                to primary health care and the Native Hawaiian Health Care Act of 1988, $1,491,522,000: Provided, That no more than $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,893,000 shall be available until expended for carrying out 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: Provided further, That the ninth provisos under the heading "Department of Health and Human Services—Health Resources and
                   Services Administration—Health Resources and Services" in Public Laws 104–208 and 105–78 are amended by striking "$80,000,000"
                   and inserting "$152,700,000" in each such ninth proviso and by adding at the end of each such ninth proviso the following
                   new proviso: "Provided further, That such costs, including the cost of modifying such loans, shall be as defined in section
                   502 of the Congressional Budget Act of 1974:".

             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, $87,798,000: 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, $731,200,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $66,593,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2)
                of such Act and $10,276,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.

             Ryan white HIV/AIDS programFor carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,260,170,000, of which $1,970,881,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through
                September 30, 2021, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That 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, $100,518,000: Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating
                   in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided
                   further, That fees pursuant to the 340B Drug Pricing Program shall be collected by the Secretary based on sales data that
                   shall be submitted by drug manufacturers and shall be credited to this account, to remain available until expended.

             Rural healthFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
                and Safety Act of 1969, and section 711 of the Social Security Act, $74,911,000.

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

             program managementFor program support in the Health Resources and Services Administration, $151,993,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings
                "Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Care Systems",
                and "Rural Health".
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0005
                      Primary Health Care (Health Centers, Free Clinics)
                      1,518
                      1,481
                      1,492

                      0010
                      Primary Health Care (Mandatory)
                      3,670
                      562
                      2

                      0015
                      Health Workforce
                      834
                      833
                      88

                      0020
                      Health Workforce (Mandatory)
                      354
                      96

                      0025
                      Maternal and Child Health
                      860
                      843
                      731

                      0030
                      Maternal and Child Health (Mandatory)
                      15

                      0035
                      Ryan White HIV/AIDS
                      2,339
                      2,369
                      2,260

                      0040
                      Health Care Systems
                      104
                      104
                      101

                      0045
                      Rural Health
                      156
                      155
                      75

                      0050
                      Family Planning
                      286
                      285
                      286

                      0055
                      HRSA Program Management
                      154
                      153
                      152

                      0300
                      Total direct programs
                      10,290
                      6,881
                      5,187

                      0799
                      Total direct obligations
                      10,290
                      6,881
                      5,187

                      0801
                      Health Resources and Services (Reimbursable)
                      73
                      53
                      60

                      0899
                      Total reimbursable obligations
                      73
                      53
                      60

                      0900
                      Total new obligations, unexpired accounts
                      10,363
                      6,934
                      5,247

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      482
                      310
                      223

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      211
                      158

                      1010
                      Unobligated balance transfer to other accts [075–1503]
                      –2

                      1010
                      Unobligated balance transfer to other accts [015–5606]

                      –5

                      1021
                      Recoveries of prior year unpaid obligations
                      84

                      1050
                      Unobligated balance (total)
                      564
                      305
                      223

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      6,213
                      6,156
                      5,185

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –14

                      1160
                      Appropriation, discretionary (total)
                      6,199
                      6,156
                      5,185

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3,975
                      645

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

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –115

                      1260
                      Appropriations, mandatory (total)
                      3,855
                      645

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      18
                      30
                      38

                      1701
                      Change in uncollected payments, Federal sources
                      10

                      1750
                      Spending auth from offsetting collections, disc (total)
                      28
                      30
                      38

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Offsetting collections (cash)(HPSL&NSL)
                      31
                      20
                      20

                      1802
                      Offsetting collections (previously unavailable)
                      2
                      2
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      31
                      21
                      21

                      1900
                      Budget authority (total)
                      10,113
                      6,852
                      5,244

                      1930
                      Total budgetary resources available
                      10,677
                      7,157
                      5,467

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –4

                      1941
                      Unexpired unobligated balance, end of year
                      310
                      223
                      220

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,702
                      7,626
                      5,702

                      3010
                      New obligations, unexpired accounts
                      10,363
                      6,934
                      5,247

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      16

                      3020
                      Outlays (gross)
                      –10,236
                      –8,858
                      –6,457

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –84

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –135

                      3050
                      Unpaid obligations, end of year
                      7,626
                      5,702
                      4,492

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –22
                      –15
                      –15

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –10

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      17

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –15
                      –15
                      –15

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,680
                      7,611
                      5,687

                      3200
                      Obligated balance, end of year
                      7,611
                      5,687
                      4,477

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      6,227
                      6,186
                      5,223

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,973
                      1,960
                      1,608

                      4011
                      Outlays from discretionary balances
                      4,152
                      4,160
                      4,213

                      4020
                      Outlays, gross (total)
                      6,125
                      6,120
                      5,821

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –13
                      –11
                      –3

                      4033
                      Non-Federal sources
                      –17
                      –19
                      –19

                      4033
                      Non-Federal sources

                      –16

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –30
                      –30
                      –38

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –10

                      4052
                      Offsetting collections credited to expired accounts
                      12

                      4060
                      Additional offsets against budget authority only (total)
                      2

                      4070
                      Budget authority, net (discretionary)
                      6,199
                      6,156
                      5,185

                      4080
                      Outlays, net (discretionary)
                      6,095
                      6,090
                      5,783

                      Mandatory:

                      4090
                      Budget authority, gross
                      3,886
                      666
                      21

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,691
                      313
                      21

                      4101
                      Outlays from mandatory balances
                      2,420
                      2,425
                      615

                      4110
                      Outlays, gross (total)
                      4,111
                      2,738
                      636

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –31
                      –20
                      –20

                      4180
                      Budget authority, net (total)
                      10,054
                      6,802
                      5,186

                      4190
                      Outlays, net (total)
                      10,175
                      8,808
                      6,399

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      2
                      1

                      5103
                      Unexpired unavailable balance, SOY: Fulfilled purpose
                      1
                      1

                      5104
                      Unexpired unavailable balance, EOY: Fulfilled purpose
                      1

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      10,054
                      6,802
                      5,186

                      Outlays
                      10,175
                      8,808
                      6,399

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      3,330
                      3,970

                      Outlays

                      1,457
                      3,508

                      Total:

                      Budget Authority
                      10,054
                      10,132
                      9,156

                      Outlays
                      10,175
                      10,265
                      9,907

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

                      Identification code 075–0350–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Guaranteed loan levels supportable by subsidy budget authority:

                      215001
                      Health centers: Facilities renovation loan guarantee levels

                      3
                      3

                      215999
                      Total loan guarantee levels

                      3
                      3

                      Guaranteed loan subsidy (in percent):

                      232001
                      Health centers: Facilities renovation loan guarantee levels
                      2.65
                      2.69
                      2.71

                      232999
                      Weighted average subsidy rate
                      0.00
                      2.69
                      2.71

                      Guaranteed loan reestimates:

                      235001
                      Health centers: Facilities renovation loan guarantee levels
                      –1

                      235999
                      Total guaranteed loan reestimates
                      –1

             Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
                activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training,
                maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical
                malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free
                clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.

             HRSA 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 2016–2017 data reported in the Annual Operating Report.

             Health Professions Revolving Loan Programs Federal Capital Contribution

                         Program
                         Account Balance

                         HPSL
                         416,265,386

                         NSL
                         188,621,972

                         PCL
                         239,076,684

                         LDS
                         157,612,046

                         Total
                         1,001,576,088

          Object Classification (in millions of dollars)

                      Identification code 075–0350–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      195
                      161
                      145

                      11.3
                      Other than full-time permanent
                      8
                      7
                      6

                      11.5
                      Other personnel compensation
                      4
                      3
                      3

                      11.7
                      Military personnel
                      21
                      18
                      17

                      11.9
                      Total personnel compensation
                      228
                      189
                      171

                      12.1
                      Civilian personnel benefits
                      65
                      53
                      48

                      12.2
                      Military personnel benefits
                      11
                      10
                      9

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      2

                      23.1
                      Rental payments to GSA
                      20
                      17
                      14

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      10
                      8
                      6

                      25.1
                      Advisory and assistance services
                      13
                      14
                      11

                      25.2
                      Other services from non-Federal sources
                      224
                      198
                      183

                      25.3
                      Other goods and services from Federal sources
                      287
                      178
                      145

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.6
                      Medical care
                      3
                      3
                      3

                      25.7
                      Operation and maintenance of equipment
                      8
                      5
                      4

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      9
                      9
                      8

                      41.0
                      Grants, subsidies, and contributions
                      9,286
                      6,103
                      4,492

                      42.0
                      Insurance claims and indemnities
                      120
                      88
                      88

                      99.0
                      Direct obligations
                      10,290
                      6,881
                      5,187

                      99.0
                      Reimbursable obligations
                      73
                      53
                      60

                      99.9
                      Total new obligations, unexpired accounts
                      10,363
                      6,934
                      5,247

          Employment Summary

                      Identification code 075–0350–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,826
                      1,485
                      1,336

                      1101
                      Direct military average strength employment
                      205
                      173
                      155

                      2001
                      Reimbursable civilian full-time equivalent employment
                      57
                      57
                      57

                      2101
                      Reimbursable military average strength employment
                      4
                      4
                      4

             Health Resources and Services

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

                      Identification code 075–0350–4–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0010
                      Primary Health Care (Mandatory)

                      3,050
                      3,595

                      0020
                      Health Workforce (Mandatory)

                      275
                      370

                      0030
                      Maternal and Child Health (Mandatory)

                      5
                      5

                      0300
                      Total direct programs

                      3,330
                      3,970

                      0900
                      Total new obligations, unexpired accounts

                      3,330
                      3,970

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      3,330
                      3,975

                      1220
                      Appropriations transferred to other acct [015–5606]

                      –5

                      1260
                      Appropriations, mandatory (total)

                      3,330
                      3,970

                      1900
                      Budget authority (total)

                      3,330
                      3,970

                      1930
                      Total budgetary resources available

                      3,330
                      3,970

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      1,873

                      3010
                      New obligations, unexpired accounts

                      3,330
                      3,970

                      3020
                      Outlays (gross)

                      –1,457
                      –3,508

                      3050
                      Unpaid obligations, end of year

                      1,873
                      2,335

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      1,873

                      3200
                      Obligated balance, end of year

                      1,873
                      2,335

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      3,330
                      3,970

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1,457
                      1,747

                      4101
                      Outlays from mandatory balances

                      1,761

                      4110
                      Outlays, gross (total)

                      1,457
                      3,508

                      4180
                      Budget authority, net (total)

                      3,330
                      3,970

                      4190
                      Outlays, net (total)

                      1,457
                      3,508

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

          Object Classification (in millions of dollars)

                      Identification code 075–0350–4–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent

                      38
                      45

                      11.3
                      Other than full-time permanent

                      1
                      1

                      11.5
                      Other personnel compensation

                      1
                      1

                      11.7
                      Military personnel

                      3
                      4

                      11.9
                      Total personnel compensation

                      43
                      51

                      12.1
                      Civilian personnel benefits

                      12
                      15

                      12.2
                      Military personnel benefits

                      2
                      2

                      23.1
                      Rental payments to GSA

                      2
                      4

                      23.3
                      Communications, utilities, and miscellaneous charges

                      2
                      2

                      25.2
                      Other services from non-Federal sources

                      28
                      28

                      25.3
                      Other goods and services from Federal sources

                      106
                      107

                      25.7
                      Operation and maintenance of equipment

                      3
                      3

                      41.0
                      Grants, subsidies, and contributions

                      3,132
                      3,758

                      99.9
                      Total new obligations, unexpired accounts

                      3,330
                      3,970

          Employment Summary

                      Identification code 075–0350–4–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      341
                      419

                      1101
                      Direct military average strength employment

                      32
                      40

             Vaccine Injury Compensation

             Program and Financing (in millions of dollars)

                      Identification code 075–0320–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      29
                      31
                      31

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      31
                      31
                      31

                      1930
                      Total budgetary resources available
                      31
                      31
                      31

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      31
                      31
                      31

                      Budget authority and outlays, net:

                      Mandatory:

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –2

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4170
                      Outlays, net (mandatory)
                      –2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –2

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

             Covered Countermeasure Process Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Claims
                      2
                      1
                      1

                      0103
                      Admin Expense

                      2
                      2

                      0900
                      Total new obligations, unexpired accounts
                      2
                      3
                      3

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      1

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

                      1050
                      Unobligated balance (total)
                      3
                      3
                      3

                      1930
                      Total budgetary resources available
                      3
                      3
                      3

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1

                      Change in obligated balance:

                      Unpaid obligations:

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

                      3010
                      New obligations, unexpired accounts
                      2
                      3
                      3

                      3020
                      Outlays (gross)
                      –2
                      –3
                      –3

                      3050
                      Unpaid obligations, end of year
                      1
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1
                      1
                      1

                      3200
                      Obligated balance, end of year
                      1
                      1
                      1

                      Budget authority and outlays, net:

                      Discretionary:

                      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 Public Health Service (PHS) Act, as amended by Division
                C of Public Law 109–148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
                resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
                has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
                claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108–20).

          Object Classification (in millions of dollars)

                      Identification code 075–0343–0–1–551
                      2017 actual
                      2018 est.
                      2019 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

                      1
                      1

                      99.0
                      Direct obligations
                      2
                      3
                      3

                      99.9
                      Total new obligations, unexpired accounts
                      2
                      3
                      3

          Employment Summary

                      Identification code 075–0343–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4
                      4

                      1101
                      Direct military average strength employment
                      2
                      2
                      2

             Maternal, Infant, and Early Childhood Home Visiting Programs

             Program and Financing (in millions of dollars)

                      Identification code 075–0321–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0010
                      Maternal, Infant, and Early Childhood Home Visiting Programs
                      408
                      13

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      37
                      13

                      1021
                      Recoveries of prior year unpaid obligations
                      12

                      1050
                      Unobligated balance (total)
                      49
                      13

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      400

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –28

                      1260
                      Appropriations, mandatory (total)
                      372

                      1930
                      Total budgetary resources available
                      421
                      13

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      13

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      739
                      719
                      360

                      3010
                      New obligations, unexpired accounts
                      408
                      13

                      3020
                      Outlays (gross)
                      –416
                      –372
                      –269

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –12

                      3050
                      Unpaid obligations, end of year
                      719
                      360
                      91

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      739
                      719
                      360

                      3200
                      Obligated balance, end of year
                      719
                      360
                      91

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      372

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11

                      4101
                      Outlays from mandatory balances
                      405
                      372
                      269

                      4110
                      Outlays, gross (total)
                      416
                      372
                      269

                      4180
                      Budget authority, net (total)
                      372

                      4190
                      Outlays, net (total)
                      416
                      372
                      269

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      372

                      Outlays
                      416
                      372
                      269

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      400
                      400

                      Outlays

                      16
                      120

                      Total:

                      Budget Authority
                      372
                      400
                      400

                      Outlays
                      416
                      388
                      389

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

          Object Classification (in millions of dollars)

                      Identification code 075–0321–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      5
                      5

                      11.7
                      Military personnel
                      1
                      1

                      11.9
                      Total personnel compensation
                      6
                      6

                      12.1
                      Civilian personnel benefits
                      2
                      2

                      25.1
                      Advisory and assistance services
                      25

                      41.0
                      Grants, subsidies, and contributions
                      375
                      5

                      99.9
                      Total new obligations, unexpired accounts
                      408
                      13

          Employment Summary

                      Identification code 075–0321–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      40
                      40

                      1101
                      Direct military average strength employment
                      3
                      3

             Maternal, Infant, and Early Childhood Home Visiting Programs

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

                      Identification code 075–0321–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0010
                      Maternal, Infant, and Early Childhood Home Visiting Programs

                      400
                      400

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      400
                      400

                      1930
                      Total budgetary resources available

                      400
                      400

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      384

                      3010
                      New obligations, unexpired accounts

                      400
                      400

                      3020
                      Outlays (gross)

                      –16
                      –120

                      3050
                      Unpaid obligations, end of year

                      384
                      664

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      384

                      3200
                      Obligated balance, end of year

                      384
                      664

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      400
                      400

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      16
                      16

                      4101
                      Outlays from mandatory balances

                      104

                      4110
                      Outlays, gross (total)

                      16
                      120

                      4180
                      Budget authority, net (total)

                      400
                      400

                      4190
                      Outlays, net (total)

                      16
                      120

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

          Object Classification (in millions of dollars)

                      Identification code 075–0321–4–1–551
                      2017 actual
                      2018 est.
                      2019 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

                      2

                      25.1
                      Advisory and assistance services

                      25
                      25

                      41.0
                      Grants, subsidies, and contributions

                      375
                      367

                      99.9
                      Total new obligations, unexpired accounts

                      400
                      400

          Employment Summary

                      Identification code 075–0321–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      40

                      1101
                      Direct military average strength employment

                      3

             Health Center Guaranteed Loan Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0742
                      Downward reestimates paid to receipt accounts
                      1

                      0900
                      Total new obligations, unexpired accounts
                      1

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      1
                      1

                      1930
                      Total budgetary resources available
                      2
                      1
                      1

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1
                      1
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      1

                      3020
                      Outlays (gross)
                      –1

                      Financing authority and disbursements, net:

                      Mandatory:

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      1

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      1

          Status of Guaranteed Loans (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Position with respect to appropriations act limitation on commitments:

                      2121
                      Limitation available from carry-forward
                      6
                      6
                      3

                      2143
                      Uncommitted limitation carried forward
                      –6
                      –3

                      2150
                      Total guaranteed loan commitments

                      3
                      3

                      2199
                      Guaranteed amount of guaranteed loan commitments

                      2
                      2

                      Cumulative balance of guaranteed loans outstanding:

                      2210
                      Outstanding, start of year
                      74
                      69
                      61

                      2231
                      Disbursements of new guaranteed loans

                      3
                      3

                      2251
                      Repayments and prepayments
                      –5
                      –10
                      –10

                      Adjustments:

                      2263
                      Terminations for default that result in claim payments

                      –1
                      –1

                      2264
                      Other adjustments, net

                      2290
                      Outstanding, end of year
                      69
                      61
                      53

                      Memorandum:

                      2299
                      Guaranteed amount of guaranteed loans outstanding, end of year
                      53
                      46
                      40

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

          Balance Sheet (in millions of dollars)

                      Identification code 075–4442–0–3–551
                      2016 actual
                      2017 actual

                      ASSETS:

                      1101
                      Federal assets: Fund balances with Treasury
                      2
                      2

                      1999
                      Total assets
                      2
                      2

                      LIABILITIES:

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

                      4999
                      Total liabilities and net position
                      2
                      2

             Medical Facilities Guarantee and Loan Fund

             Status of Direct Loans (in millions of dollars)

                      Identification code 075–9931–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      6
                      5
                      5

                      1251
                      Repayments: Repayments and prepayments
                      –1

                      1290
                      Outstanding, end of year
                      5
                      5
                      5

             Titles VI and XVI of the PHS Act established a loan and loan guarantee fund for medical facilities with a maximum amount allowable
                for the Government's liability. Direct loans were made available for public facilities and guaranteed loans for private, nonprofit
                facilities. Funds under this authority were established in the amount of $50 million for use in fulfilling guarantees in the
                event of default, $30 million as a revolving fund for direct loans, and an amount for interest subsidy payments on guaranteed
                loans.

          Balance Sheet (in millions of dollars)

                      Identification code 075–9931–0–3–551
                      2016 actual
                      2017 actual

                      ASSETS:

                      1601
                      Direct loans, gross
                      6
                      5

                      1999
                      Total assets
                      6
                      5

                      LIABILITIES:

                      2201
                      Non-Federal liabilities: Accounts payable
                      6
                      5

                      4999
                      Total liabilities and net position
                      6
                      5

          Trust Funds
             Vaccine injury compensation program trust fundFor payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
                claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
                to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $9,200,000 shall be available from the Trust Fund to the Secretary.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      3,571
                      3,619
                      3,689

                      Receipts:

                      Current law:

                      1110
                      Deposits, Vaccine Injury Compensation Trust Fund
                      270
                      296
                      303

                      1140
                      Interest and Profits on Investments, Vaccine Injury Compensation Trust Fund
                      84
                      106
                      114

                      1199
                      Total current law receipts
                      354
                      402
                      417

                      1999
                      Total receipts
                      354
                      402
                      417

                      2000
                      Total: Balances and receipts
                      3,925
                      4,021
                      4,106

                      Appropriations:

                      Current law:

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –24
                      –24
                      –27

                      2101
                      Vaccine Injury Compensation Program Trust Fund
                      –282
                      –308
                      –308

                      2199
                      Total current law appropriations
                      –306
                      –332
                      –335

                      2999
                      Total appropriations
                      –306
                      –332
                      –335

                      5099
                      Balance, end of year
                      3,619
                      3,689
                      3,771

          Program and Financing (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Compensation: Claims for post - FY 1989 injuries
                      282
                      308
                      308

                      0103
                      Claims processing (Claims Court)
                      6
                      6
                      9

                      0104
                      Claims processing (HRSA)
                      8
                      8
                      9

                      0105
                      Claims processing (Dept. of Justice)
                      10
                      10
                      9

                      0191
                      Direct program activities, subtotal
                      24
                      24
                      27

                      0900
                      Total new obligations, unexpired accounts
                      306
                      332
                      335

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1033
                      Recoveries of prior year paid obligations
                      4

                      1035
                      Unobligated balance of appropriations withdrawn
                      –7

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      24
                      24
                      27

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      282
                      308
                      308

                      1900
                      Budget authority (total)
                      306
                      332
                      335

                      1930
                      Total budgetary resources available
                      306
                      332
                      335

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      13
                      9

                      3010
                      New obligations, unexpired accounts
                      306
                      332
                      335

                      3020
                      Outlays (gross)
                      –307
                      –341
                      –335

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3050
                      Unpaid obligations, end of year
                      9

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      13
                      9

                      3200
                      Obligated balance, end of year
                      9

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      24
                      24
                      27

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      17
                      24
                      27

                      4011
                      Outlays from discretionary balances
                      8

                      4020
                      Outlays, gross (total)
                      25
                      24
                      27

                      Mandatory:

                      4090
                      Budget authority, gross
                      282
                      308
                      308

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      282
                      308
                      308

                      4101
                      Outlays from mandatory balances

                      9

                      4110
                      Outlays, gross (total)
                      282
                      317
                      308

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –4

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      4

                      4160
                      Budget authority, net (mandatory)
                      282
                      308
                      308

                      4170
                      Outlays, net (mandatory)
                      278
                      317
                      308

                      4180
                      Budget authority, net (total)
                      306
                      332
                      335

                      4190
                      Outlays, net (total)
                      303
                      341
                      335

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      3,605
                      3,595
                      3,689

                      5001
                      Total investments, EOY: Federal securities: Par value
                      3,595
                      3,689
                      3,798

             The Vaccine Injury Compensation Program was established pursuant to Public Law 99–660 and Public Law 100–203 and serves as
                a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
                for vaccine-related injury or death occurring after October 1, 1988.

          Object Classification (in millions of dollars)

                      Identification code 075–8175–0–7–551
                      2017 actual
                      2018 est.
                      2019 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
                      299
                      325
                      328

                      99.9
                      Total new obligations, unexpired accounts
                      306
                      332
                      335

          Employment Summary

                      Identification code 075–8175–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      14
                      14
                      16

                      1101
                      Direct military average strength employment
                      6
                      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, $3,850,529,000, 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, $932,492,000 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, $11,000,000 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 not less than $58,000,000 shall be for accreditation emergencies, including supplementing activities funded under the heading "Indian Health Facilities":  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 in the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding
                section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and
                scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That, notwithstanding any other provision of law, the amounts made available within this account for the Substance Abuse
                and Suicide Prevention Program, for the Domestic Violence Prevention Program, to improve collections from public and private
                insurance at Indian Health Service and tribally operated facilities, and for accreditation emergencies shall be allocated
                at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the
                total obligation is recorded in the year the funds are appropriated: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health
                Care Improvement Act shall remain available until expended for the purpose of achieving compliance with the applicable conditions
                and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or
                construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall
                remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall
                be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating
                health facilities pursuant to Public Law 93–638, such individually identifiable health information relating to disabled children
                as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
                U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
                Indian Health Facilities account.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Clinical services
                      3,359
                      3,336
                      3,599

                      0002
                      Preventive health
                      160
                      159
                      86

                      0003
                      Urban health
                      48
                      47
                      45

                      0004
                      Indian health professions
                      49
                      49
                      43

                      0005
                      Tribal management
                      2
                      2

                      0006
                      Direct operations
                      70
                      70
                      72

                      0007
                      Self-governance
                      6
                      6
                      5

                      0009
                      Diabetes funds
                      147
                      150
                      150

                      0799
                      Total direct obligations
                      3,841
                      3,819
                      4,000

                      0801
                      Indian Health Services (Reimbursable)
                      1,557
                      1,193
                      1,193

                      0900
                      Total new obligations, unexpired accounts
                      5,398
                      5,012
                      5,193

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      829
                      1,007
                      1,199

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      829
                      1,007

                      1021
                      Recoveries of prior year unpaid obligations
                      192

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      1,023
                      1,007
                      1,199

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,694
                      3,681
                      3,850

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      151
                      75

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –3

                      1260
                      Appropriations, mandatory (total)
                      148
                      75

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,545
                      1,448
                      1,450

                      1701
                      Change in uncollected payments, Federal sources
                      3

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,548
                      1,448
                      1,450

                      1900
                      Budget authority (total)
                      5,390
                      5,204
                      5,300

                      1930
                      Total budgetary resources available
                      6,413
                      6,211
                      6,499

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –8

                      1941
                      Unexpired unobligated balance, end of year
                      1,007
                      1,199
                      1,306

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      983
                      1,034
                      600

                      3010
                      New obligations, unexpired accounts
                      5,398
                      5,012
                      5,193

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      42

                      3020
                      Outlays (gross)
                      –5,164
                      –5,446
                      –5,273

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –192

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –33

                      3050
                      Unpaid obligations, end of year
                      1,034
                      600
                      520

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –98
                      –100
                      –100

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

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –100
                      –100
                      –100

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      885
                      934
                      500

                      3200
                      Obligated balance, end of year
                      934
                      500
                      420

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      5,242
                      5,129
                      5,300

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,177
                      4,466
                      4,607

                      4011
                      Outlays from discretionary balances
                      847
                      902
                      663

                      4020
                      Outlays, gross (total)
                      5,024
                      5,368
                      5,270

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –476
                      –276
                      –276

                      4033
                      Non-Federal sources
                      –1,075
                      –1,172
                      –1,174

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,551
                      –1,448
                      –1,450

                      Additional offsets against gross budget authority only:

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

                      4052
                      Offsetting collections credited to expired accounts
                      4

                      4053
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4060
                      Additional offsets against budget authority only (total)
                      3

                      4070
                      Budget authority, net (discretionary)
                      3,694
                      3,681
                      3,850

                      4080
                      Outlays, net (discretionary)
                      3,473
                      3,920
                      3,820

                      Mandatory:

                      4090
                      Budget authority, gross
                      148
                      75

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      47
                      72

                      4101
                      Outlays from mandatory balances
                      93
                      6
                      3

                      4110
                      Outlays, gross (total)
                      140
                      78
                      3

                      4180
                      Budget authority, net (total)
                      3,842
                      3,756
                      3,850

                      4190
                      Outlays, net (total)
                      3,613
                      3,998
                      3,823

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      3,842
                      3,756
                      3,850

                      Outlays
                      3,613
                      3,998
                      3,823

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      75
                      150

                      Outlays

                      72
                      147

                      Total:

                      Budget Authority
                      3,842
                      3,831
                      4,000

                      Outlays
                      3,613
                      4,070
                      3,970

             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 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–0390–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      397
                      397
                      415

                      11.3
                      Other than full-time permanent
                      18
                      18
                      19

                      11.5
                      Other personnel compensation
                      60
                      60
                      62

                      11.7
                      Military personnel
                      62
                      62
                      65

                      11.9
                      Total personnel compensation
                      537
                      537
                      561

                      12.1
                      Civilian personnel benefits
                      159
                      159
                      167

                      12.2
                      Military personnel benefits
                      27
                      27
                      28

                      13.0
                      Benefits for former personnel
                      10
                      10
                      10

                      21.0
                      Patient travel
                      43
                      43
                      44

                      22.0
                      Transportation of things
                      7
                      7
                      8

                      23.1
                      Rental payments to GSA
                      16
                      16
                      17

                      23.2
                      Rental payments to others
                      2
                      2
                      2

                      23.3
                      Communications, utilities, and miscellaneous charges
                      13
                      13
                      14

                      25.1
                      Advisory and assistance services
                      6
                      6
                      6

                      25.2
                      Other services from non-Federal sources
                      105
                      104
                      110

                      25.3
                      Other goods and services from Federal sources
                      76
                      76
                      84

                      25.4
                      Operation and maintenance of facilities
                      2
                      2
                      2

                      25.6
                      Medical care
                      380
                      377
                      382

                      25.7
                      Operation and maintenance of equipment
                      14
                      14
                      15

                      25.8
                      Subsistence and support of persons
                      3
                      3
                      3

                      26.0
                      Supplies and materials
                      92
                      91
                      100

                      31.0
                      Equipment
                      12
                      12
                      13

                      41.0
                      Grants, subsidies, and contributions
                      2,337
                      2,319
                      2,433

                      42.0
                      Insurance claims and indemnities

                      1
                      1

                      99.0
                      Direct obligations
                      3,841
                      3,819
                      4,000

                      99.0
                      Reimbursable obligations
                      1,557
                      1,193
                      1,193

                      99.9
                      Total new obligations, unexpired accounts
                      5,398
                      5,012
                      5,193

          Employment Summary

                      Identification code 075–0390–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      6,705
                      6,705
                      7,204

                      1101
                      Direct military average strength employment
                      932
                      932
                      964

                      2001
                      Reimbursable civilian full-time equivalent employment
                      5,684
                      6,584
                      5,710

                      2101
                      Reimbursable military average strength employment
                      790
                      790
                      764

             Indian Health Services

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

                      Identification code 075–0390–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0009
                      Diabetes funds

                      75
                      150

                      0100
                      Direct program activities, subtotal

                      75
                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      75
                      150

                      1900
                      Budget authority (total)

                      75
                      150

                      1930
                      Total budgetary resources available

                      75
                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      3

                      3010
                      New obligations, unexpired accounts

                      75
                      150

                      3020
                      Outlays (gross)

                      –72
                      –147

                      3050
                      Unpaid obligations, end of year

                      3
                      6

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      3

                      3200
                      Obligated balance, end of year

                      3
                      6

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      75
                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      72
                      144

                      4101
                      Outlays from mandatory balances

                      3

                      4110
                      Outlays, gross (total)

                      72
                      147

                      4180
                      Budget authority, net (total)

                      75
                      150

                      4190
                      Outlays, net (total)

                      72
                      147

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

          Object Classification (in millions of dollars)

                      Identification code 075–0390–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      21.0
                      Patient travel

                      1
                      2

                      22.0
                      Transportation of things

                      1

                      25.2
                      Other services from non-Federal sources

                      3
                      5

                      25.4
                      Operation and maintenance of facilities

                      2
                      3

                      25.6
                      Medical care

                      10
                      20

                      25.7
                      Operation and maintenance of equipment

                      1

                      26.0
                      Supplies and materials

                      3
                      5

                      31.0
                      Equipment

                      1

                      41.0
                      Grants, subsidies, and contributions

                      56
                      112

                      99.9
                      Total new obligations, unexpired accounts

                      75
                      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 2019, such sums as may be necessary: Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements
                for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal
                years: Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
                to another budget account.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0344–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Contract Support Costs
                      712
                      795
                      797

                      0900
                      Total new obligations (object class 25.3)
                      712
                      795
                      797

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      712
                      795
                      797

                      1930
                      Total budgetary resources available
                      712
                      795
                      797

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      39
                      48

                      3010
                      New obligations, unexpired accounts
                      712
                      795
                      797

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      62

                      3020
                      Outlays (gross)
                      –716
                      –843
                      –797

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –49

                      3050
                      Unpaid obligations, end of year
                      48

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      39
                      48

                      3200
                      Obligated balance, end of year
                      48

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      712
                      795
                      797

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      688
                      795
                      797

                      4011
                      Outlays from discretionary balances
                      28
                      48

                      4020
                      Outlays, gross (total)
                      716
                      843
                      797

                      4180
                      Budget authority, net (total)
                      712
                      795
                      797

                      4190
                      Outlays, net (total)
                      716
                      843
                      797

             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 $797 million in contract support
                costs funds will be provided to tribal governments and tribal organizations in 2019.

             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,  $426,267,000, to remain available until expended: Provided, That, notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation
                or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such
                facilities will be located: Provided further, That not to exceed $500,000 may be used by the Indian Health Service to purchase TRANSAM equipment from the Department of
                Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for
                new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development: Provided further, That not to exceed $2,700,000 from this account and the "Indian Health Services" account may be used by the Indian Health
                Service to obtain ambulances for the Indian Health Service and tribal facilities in conjunction with an existing interagency
                agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed $500,000 may be placed in a Demolition Fund, to remain available until expended, and be used by the Indian
                Health Service for the demolition of Federal buildings.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Rent and Charges for Quarters, Indian Health Service
                      8
                      9
                      9

                      2000
                      Total: Balances and receipts
                      8
                      9
                      9

                      Appropriations:

                      Current law:

                      2101
                      Indian Health Facilities
                      –8
                      –9
                      –9

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Maintenance
                      220
                      218
                      140

                      0002
                      Maintenance
                      78
                      75
                      60

                      0003
                      Facilities and environmental health
                      227
                      225
                      207

                      0004
                      Equipment
                      23
                      23
                      20

                      0100
                      Total direct program
                      548
                      541
                      427

                      0799
                      Total direct obligations
                      548
                      541
                      427

                      0801
                      Indian Health Facilities (Reimbursable)
                      25
                      9
                      9

                      0900
                      Total new obligations, unexpired accounts
                      573
                      550
                      436

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      285
                      309
                      366

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      285
                      309

                      1021
                      Recoveries of prior year unpaid obligations
                      11

                      1050
                      Unobligated balance (total)
                      296
                      309
                      366

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      545
                      541
                      427

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      8
                      9
                      9

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      32
                      57
                      57

                      1701
                      Change in uncollected payments, Federal sources
                      1

                      1750
                      Spending auth from offsetting collections, disc (total)
                      33
                      57
                      57

                      1900
                      Budget authority (total)
                      586
                      607
                      493

                      1930
                      Total budgetary resources available
                      882
                      916
                      859

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      309
                      366
                      423

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      491
                      575
                      532

                      3010
                      New obligations, unexpired accounts
                      573
                      550
                      436

                      3020
                      Outlays (gross)
                      –478
                      –593
                      –570

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –11

                      3050
                      Unpaid obligations, end of year
                      575
                      532
                      398

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –8
                      –9
                      –9

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –1

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –9
                      –9
                      –9

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      483
                      566
                      523

                      3200
                      Obligated balance, end of year
                      566
                      523
                      389

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      578
                      598
                      484

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      267
                      219
                      185

                      4011
                      Outlays from discretionary balances
                      202
                      365
                      376

                      4020
                      Outlays, gross (total)
                      469
                      584
                      561

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –32
                      –57
                      –57

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –32
                      –57
                      –57

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –1

                      4070
                      Budget authority, net (discretionary)
                      545
                      541
                      427

                      4080
                      Outlays, net (discretionary)
                      437
                      527
                      504

                      Mandatory:

                      4090
                      Budget authority, gross
                      8
                      9
                      9

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3
                      9
                      9

                      4101
                      Outlays from mandatory balances
                      6

                      4110
                      Outlays, gross (total)
                      9
                      9
                      9

                      4180
                      Budget authority, net (total)
                      553
                      550
                      436

                      4190
                      Outlays, net (total)
                      446
                      536
                      513

             The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
                facilities support for the Indian Health Service. More than 169 million, primarily through self-determination contracts and
                compacts, will be administered by tribal governments in 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–0391–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      51
                      51
                      57

                      11.3
                      Other than full-time permanent
                      2
                      2
                      3

                      11.5
                      Other personnel compensation
                      3
                      3
                      3

                      11.7
                      Military personnel
                      22
                      22
                      20

                      11.9
                      Total personnel compensation
                      78
                      78
                      83

                      12.1
                      Civilian personnel benefits
                      18
                      18
                      20

                      12.2
                      Military personnel benefits
                      8
                      8
                      9

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      2

                      22.0
                      Transportation of things
                      3
                      3
                      3

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      14
                      15
                      12

                      25.1
                      Advisory and assistance services
                      3
                      3
                      2

                      25.2
                      Other services from non-Federal sources
                      109
                      108
                      71

                      25.3
                      Other goods and services from Federal sources
                      2
                      3
                      2

                      25.4
                      Operation and maintenance of facilities
                      8
                      8
                      6

                      25.7
                      Operation and maintenance of equipment
                      4
                      4
                      3

                      25.8
                      Subsistence and support of persons
                      8
                      8
                      5

                      26.0
                      Supplies and materials
                      7
                      7
                      6

                      31.0
                      Equipment
                      13
                      13
                      10

                      32.0
                      Land and structures
                      80
                      79
                      55

                      41.0
                      Grants, subsidies, and contributions
                      189
                      182
                      137

                      99.0
                      Direct obligations
                      548
                      541
                      427

                      99.0
                      Reimbursable obligations
                      25
                      9
                      9

                      99.9
                      Total new obligations, unexpired accounts
                      573
                      550
                      436

          Employment Summary

                      Identification code 075–0391–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      968
                      968
                      976

                      1101
                      Direct military average strength employment
                      147
                      147
                      141

                      2001
                      Reimbursable civilian full-time equivalent employment
                      37
                      37
                      37

             ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

             Administrative provisions—indian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
                3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
                5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
                and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
                in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
                5 U.S.C. 5901–5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
                Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
                care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
                recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651–2653) shall be credited to the account of the facility
                providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
                to the Indian Health Service shall be administered under Public Law 86–121, the Indian Sanitation Facilities Act and Public
                Law 93–638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
                purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
                by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
                the House and Senate Committees on Appropriations are notified through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization
                through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance
                Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance
                agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal
                year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule
                published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility
                for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting
                the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and
                enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health
                Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance
                with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant
                to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds
                were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total
                costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance:
                Provided further, That, notwithstanding any other provision of law, for any lease under section 105(l) of the Indian Self-Determination and
                Education Assistance Act, as amended, no additional compensation is required by the Act above the amount provided to the tribe
                or tribal organization under section 106(a)(1), except the Secretary, in the discretion of the Secretary, may award compensation
                for such leases, above the section 106(a)(1) amount, and if the Secretary awards such additional compensation the amount of
                such compensation may be based on such reasonable expenses, if any, as the Secretary determines to be appropriate, which may
                include the expenses described in section 105(l)(2), and the exercise of this discretion to award additional compensation
                and determine its amount is not subject to sections 102(a)-(b), (e) or 507(b)-(d) of the Act.

             Centers for Disease Control and Prevention

             Federal Funds
             Immunization and respiratory diseasesFor carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
                Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $437,828,000.

             HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis preventionFor carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
                diseases, and tuberculosis prevention, $1,067,278,000.

             Emerging and zoonotic infectious diseasesFor carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
                Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $371,328,000: 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, $439,250,000: 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, $110,000,000.

             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, $332,180,000: Provided, That in addition to amounts provided herein, $135,820,000 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, $266,309,000.

             National Institute for Occupational Safety and Health

             Energy employees occupational illness compensation program

             Global healthFor carrying out titles II, III, and XVII of the PHS Act with respect to global health, $408,762,000, of which $69,547,000 for international HIV/AIDS  shall remain available through September 30, 2020 and $58,762,000 for global public health protection shall remain available through September 30, 2020: 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, $691,000,000: 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.

             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, 2020: Provided further, That the Director may transfer discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of
                1985) which are appropriated for the current fiscal year for CDC in this Act between any of the accounts of CDC with notification
                to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account
                shall be decreased by more than 3 percent by any such transfer.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

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

                      2000
                      Total: Balances and receipts
                      1
                      2
                      2

                      Appropriations:

                      Current law:

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

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Birth Defects, Developmental Disabilities, Disability and Health (0958)
                      137
                      137
                      110

                      0002
                      CDC-Wide Activities and Program Support (0943)
                      323
                      257
                      105

                      0004
                      Chronic Disease Prevention and Health Promotion (0948)
                      1,109
                      1,078
                      839

                      0005
                      Emerging and Zoonotic Infectious Diseases (0949)
                      584
                      568
                      508

                      0006
                      Energy Employee Illness Occupational Compensation Program Act (EEOICPA) (0954)
                      51
                      55

                      0007
                      Environmental Health (0947)
                      189
                      178
                      157

                      0008
                      Global Health (0955)
                      438
                      432
                      409

                      0012
                      HIV/AIDS, Viral Hepatitis, STD and TB Prevention (0950)
                      1,114
                      1,110
                      1,067

                      0013
                      Immunization and Respiratory Diseases (0951)
                      802
                      745
                      701

                      0015
                      Injury Prevention and Control (0952)
                      285
                      284
                      266

                      0016
                      Occupational Safety and Health (0953)
                      334
                      333

                      0019
                      Public Health Preparedness and Response (0956)
                      1,393
                      1,395
                      691

                      0020
                      Public Health Scientific Services (0959)
                      488
                      494
                      332

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

                      0022
                      Ebola (Emergency pursuant to 2011 BCA)
                      352
                      157
                      72

                      0023
                      Zika (Emergency pursuant to 2011 BCA)
                      397

                      0799
                      Total direct obligations
                      7,997
                      7,223
                      5,257

                      0802
                      CDC-Wide Activities and Program Support (Reimbursable)
                      197
                      197
                      197

                      0809
                      Reimbursable program activities, subtotal
                      197
                      197
                      197

                      0900
                      Total new obligations, unexpired accounts
                      8,194
                      7,420
                      5,454

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,157
                      471
                      522

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1,040
                      471

                      1010
                      Unobligated balance transfer to other accts [075–0960]
                      –4

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

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      23

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      28

                      1021
                      Recoveries of prior year unpaid obligations
                      57

                      1033
                      Recoveries of prior year paid obligations
                      2

                      1050
                      Unobligated balance (total)
                      1,260
                      471
                      522

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      6,284
                      6,207
                      4,386

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –14

                      1121
                      Appropriations transferred from other acct (CHIMPS) [075–0116]

                      805

                      1130
                      Appropriations permanently reduced

                      –5

                      1160
                      Appropriation, discretionary (total)
                      6,270
                      7,007
                      4,386

                      Appropriations, mandatory:

                      1200
                      Appropriation (075–0954 - EEOICPA)
                      55
                      55

                      1201
                      Appropriation (075–5146 CRADA)
                      1
                      2
                      2

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

                      800

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

                      1260
                      Appropriations, mandatory (total)
                      942
                      52
                      802

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      177
                      408
                      408

                      1701
                      Change in uncollected payments, Federal sources
                      16

                      1750
                      Spending auth from offsetting collections, disc (total)
                      193
                      408
                      408

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      5
                      4
                      4

                      1900
                      Budget authority (total)
                      7,410
                      7,471
                      5,600

                      1930
                      Total budgetary resources available
                      8,670
                      7,942
                      6,122

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –5

                      1941
                      Unexpired unobligated balance, end of year
                      471
                      522
                      668

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      6,951
                      7,137
                      6,486

                      3010
                      New obligations, unexpired accounts
                      8,194
                      7,420
                      5,454

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      61

                      3020
                      Outlays (gross)
                      –7,826
                      –8,071
                      –7,317

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –57

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –186

                      3050
                      Unpaid obligations, end of year
                      7,137
                      6,486
                      4,623

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –233
                      –190
                      –190

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –16

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      59

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –190
                      –190
                      –190

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      6,718
                      6,947
                      6,296

                      3200
                      Obligated balance, end of year
                      6,947
                      6,296
                      4,433

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      6,463
                      7,415
                      4,794

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,502
                      3,045
                      2,119

                      4011
                      Outlays from discretionary balances
                      4,288
                      4,166
                      4,800

                      4020
                      Outlays, gross (total)
                      6,790
                      7,211
                      6,919

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –222
                      –408
                      –408

                      4033
                      Non-Federal sources
                      –10

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –232
                      –408
                      –408

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –16

                      4052
                      Offsetting collections credited to expired accounts
                      55

                      4060
                      Additional offsets against budget authority only (total)
                      39

                      4070
                      Budget authority, net (discretionary)
                      6,270
                      7,007
                      4,386

                      4080
                      Outlays, net (discretionary)
                      6,558
                      6,803
                      6,511

                      Mandatory:

                      4090
                      Budget authority, gross
                      947
                      56
                      806

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      212
                      42
                      165

                      4101
                      Outlays from mandatory balances
                      824
                      818
                      233

                      4110
                      Outlays, gross (total)
                      1,036
                      860
                      398

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –7
                      –4
                      –4

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      2

                      4160
                      Budget authority, net (mandatory)
                      942
                      52
                      802

                      4170
                      Outlays, net (mandatory)
                      1,029
                      856
                      394

                      4180
                      Budget authority, net (total)
                      7,212
                      7,059
                      5,188

                      4190
                      Outlays, net (total)
                      7,587
                      7,659
                      6,905

             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,
                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 2019 Budget maintains the proposal to establish a new block grant, proposed at $400
                million, to increase flexibility for States to address their population's unique public health needs.

          Object Classification (in millions of dollars)

                      Identification code 075–0943–0–1–999
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      759
                      801
                      803

                      11.3
                      Other than full-time permanent
                      117
                      101
                      102

                      11.5
                      Other personnel compensation
                      40
                      37
                      37

                      11.7
                      Military personnel
                      81
                      75
                      76

                      11.8
                      Special personal services payments
                      8
                      8
                      8

                      11.9
                      Total personnel compensation
                      1,005
                      1,022
                      1,026

                      12.1
                      Civilian personnel benefits
                      301
                      307
                      309

                      12.2
                      Military personnel benefits
                      55
                      50
                      50

                      21.0
                      Travel and transportation of persons
                      60
                      42
                      32

                      22.0
                      Transportation of things
                      16
                      14
                      11

                      23.1
                      Rental payments to GSA
                      8
                      27
                      21

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      22
                      34
                      28

                      24.0
                      Printing and reproduction
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      876
                      865
                      334

                      25.2
                      Other services from non-Federal sources
                      177
                      224
                      74

                      25.3
                      Other goods and services from Federal sources
                      783
                      443
                      149

                      25.4
                      Operation and maintenance of facilities
                      17
                      21
                      10

                      25.5
                      Research and development contracts
                      28
                      26
                      8

                      25.6
                      Medical care
                      44
                      38
                      12

                      25.7
                      Operation and maintenance of equipment
                      51
                      86
                      29

                      26.0
                      Supplies and materials
                      515
                      472
                      401

                      31.0
                      Equipment
                      62
                      64
                      52

                      32.0
                      Land and structures
                      1
                      7
                      5

                      41.0
                      Grants, subsidies, and contributions
                      3,971
                      3,476
                      2,701

                      42.0
                      Insurance claims and indemnities
                      1
                      1
                      1

                      99.0
                      Direct obligations
                      7,997
                      7,223
                      5,257

                      99.0
                      Reimbursable obligations
                      197
                      197
                      197

                      99.9
                      Total new obligations, unexpired accounts
                      8,194
                      7,420
                      5,454

          Employment Summary

                      Identification code 075–0943–0–1–999
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      9,079
                      8,620
                      7,520

                      1101
                      Direct military average strength employment
                      858
                      788
                      694

                      2001
                      Reimbursable civilian full-time equivalent employment
                      218
                      218
                      218

                      2101
                      Reimbursable military average strength employment
                      37
                      37
                      37

             buildings and facilitiesFor acquisition of real property, equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2023.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2017 actual
                      2018 est.
                      2019 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
                      3
                      8
                      8

                      1011
                      Unobligated balance transfer from other acct [075–0943]
                      4

                      1050
                      Unobligated balance (total)
                      7
                      8
                      8

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      10
                      10
                      20

                      1930
                      Total budgetary resources available
                      17
                      18
                      28

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      8
                      8
                      8

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7
                      9
                      9

                      3010
                      New obligations, unexpired accounts
                      9
                      10
                      20

                      3020
                      Outlays (gross)
                      –7
                      –10
                      –14

                      3050
                      Unpaid obligations, end of year
                      9
                      9
                      15

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7
                      9
                      9

                      3200
                      Obligated balance, end of year
                      9
                      9
                      15

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      10
                      10
                      20

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1
                      4
                      8

                      4011
                      Outlays from discretionary balances
                      6
                      6
                      6

                      4020
                      Outlays, gross (total)
                      7
                      10
                      14

                      4180
                      Budget authority, net (total)
                      10
                      10
                      20

                      4190
                      Outlays, net (total)
                      7
                      10
                      14

          Object Classification (in millions of dollars)

                      Identification code 075–0960–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      1
                      1
                      1

                      25.4
                      Operation and maintenance of facilities
                      8
                      9
                      19

                      99.9
                      Total new obligations, unexpired accounts
                      9
                      10
                      20

             CDC Working Capital Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–4553–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      CDC Working Capital Fund (Reimbursable)
                      549
                      532
                      532

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      53
                      55
                      55

                      1021
                      Recoveries of prior year unpaid obligations
                      15

                      1050
                      Unobligated balance (total)
                      68
                      55
                      55

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      537
                      532
                      532

                      1701
                      Change in uncollected payments, Federal sources
                      –1

                      1750
                      Spending auth from offsetting collections, disc (total)
                      536
                      532
                      532

                      1930
                      Total budgetary resources available
                      604
                      587
                      587

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      55
                      55
                      55

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      217
                      195
                      193

                      3010
                      New obligations, unexpired accounts
                      549
                      532
                      532

                      3020
                      Outlays (gross)
                      –556
                      –534
                      –532

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –15

                      3050
                      Unpaid obligations, end of year
                      195
                      193
                      193

                      Uncollected payments:

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

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      1

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      215
                      194
                      192

                      3200
                      Obligated balance, end of year
                      194
                      192
                      192

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      536
                      532
                      532

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      385
                      351
                      351

                      4011
                      Outlays from discretionary balances
                      171
                      183
                      181

                      4020
                      Outlays, gross (total)
                      556
                      534
                      532

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –537
                      –532
                      –532

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      4080
                      Outlays, net (discretionary)
                      19
                      2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      19
                      2

             Implemented in fiscal year 2014, CDC's Working Capital Fund has extended availability and serves as the funding mechanism
                to finance centralized business services support across CDC. Services rendered under the fund are performed at pre-established
                rates that are used to cover the full cost of operations and future investments. Contributions are collected for services,
                thereby creating market-like incentives to maximize efficiency and quality.

          Object Classification (in millions of dollars)

                      Identification code 075–4553–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      148
                      148
                      148

                      11.3
                      Other than full-time permanent
                      4
                      4
                      4

                      11.5
                      Other personnel compensation
                      4
                      4
                      4

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      159
                      159
                      159

                      12.1
                      Civilian personnel benefits
                      50
                      50
                      50

                      12.2
                      Military personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      22.0
                      Transportation of things
                      2
                      2
                      2

                      23.1
                      Rental payments to GSA
                      32
                      32
                      32

                      23.3
                      Communications, utilities, and miscellaneous charges
                      22
                      22
                      22

                      25.1
                      Advisory and assistance services
                      31
                      31
                      31

                      25.2
                      Other services from non-Federal sources
                      86
                      77
                      77

                      25.3
                      Other goods and services from Federal sources
                      76
                      68
                      68

                      25.4
                      Operation and maintenance of facilities
                      10
                      10
                      10

                      25.7
                      Operation and maintenance of equipment
                      57
                      57
                      57

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      31.0
                      Equipment
                      12
                      12
                      12

                      32.0
                      Land and structures
                      8
                      8
                      8

                      99.9
                      Total new obligations, unexpired accounts
                      549
                      532
                      532

          Employment Summary

                      Identification code 075–4553–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,276
                      1,276
                      1,276

                      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 2019, and existing profiles may be updated as necessary.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Agency for Toxic Substances and Disease Registry, Toxic Substanc (Direct)
                      81
                      74
                      62

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      26
                      25
                      28

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      75
                      74
                      62

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3
                      3
                      3

                      1701
                      Change in uncollected payments, Federal sources
                      2

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

                      1900
                      Budget authority (total)
                      80
                      77
                      65

                      1930
                      Total budgetary resources available
                      106
                      102
                      93

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      25
                      28
                      31

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      46
                      40
                      19

                      3010
                      New obligations, unexpired accounts
                      81
                      74
                      62

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

                      3020
                      Outlays (gross)
                      –85
                      –95
                      –75

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –4

                      3050
                      Unpaid obligations, end of year
                      40
                      19
                      6

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5
                      –4
                      –4

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

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      3

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –4
                      –4
                      –4

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      41
                      36
                      15

                      3200
                      Obligated balance, end of year
                      36
                      15
                      2

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      80
                      77
                      65

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      52
                      52
                      44

                      4011
                      Outlays from discretionary balances
                      30
                      43
                      31

                      4020
                      Outlays, gross (total)
                      82
                      95
                      75

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –6
                      –3
                      –3

                      4033
                      Non-Federal sources
                      –1

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –7
                      –3
                      –3

                      Additional offsets against gross budget authority only:

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

                      4052
                      Offsetting collections credited to expired accounts
                      4

                      4060
                      Additional offsets against budget authority only (total)
                      2

                      4070
                      Budget authority, net (discretionary)
                      75
                      74
                      62

                      4080
                      Outlays, net (discretionary)
                      75
                      92
                      72

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      3

                      4180
                      Budget authority, net (total)
                      75
                      74
                      62

                      4190
                      Outlays, net (total)
                      78
                      92
                      72

          Object Classification (in millions of dollars)

                      Identification code 075–0944–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      22
                      22
                      22

                      11.3
                      Other than full-time permanent
                      2
                      2
                      2

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      28
                      28
                      28

                      12.1
                      Civilian personnel benefits
                      8
                      8
                      8

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      8
                      8
                      3

                      25.2
                      Other services from non-Federal sources
                      5
                      5
                      3

                      25.3
                      Other goods and services from Federal sources
                      9
                      9
                      4

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      16
                      13
                      13

                      99.0
                      Direct obligations
                      77
                      74
                      62

                      99.0
                      Reimbursable obligations
                      4

                      99.9
                      Total new obligations, unexpired accounts
                      81
                      74
                      62

          Employment Summary

                      Identification code 075–0944–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      219
                      219
                      219

                      1101
                      Direct military average strength employment
                      36
                      36
                      36

             World Trade Center Health Program Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      World Trade Center Health Program—Federal Share (CDC/NIOSH)
                      351
                      420
                      469

                      0002
                      World Trade Center Health Program—NYC
                      39
                      42
                      52

                      0900
                      Total new obligations, unexpired accounts
                      390
                      462
                      521

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      799
                      870
                      913

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      62
                      83
                      83

                      1021
                      Recoveries of prior year unpaid obligations
                      15

                      1050
                      Unobligated balance (total)
                      876
                      953
                      996

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (WTC (CDC Direct))
                      320
                      380
                      440

                      1200
                      Appropriation (WTC—NYC DHSS—CDC)
                      36
                      42
                      49

                      1260
                      Appropriations, mandatory (total)
                      356
                      422
                      489

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      28

                      1900
                      Budget authority (total)
                      384
                      422
                      489

                      1930
                      Total budgetary resources available
                      1,260
                      1,375
                      1,485

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      870
                      913
                      964

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      168
                      184
                      301

                      3010
                      New obligations, unexpired accounts
                      390
                      462
                      521

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

                      3020
                      Outlays (gross)
                      –342
                      –345
                      –415

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –15

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –19

                      3050
                      Unpaid obligations, end of year
                      184
                      301
                      407

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      168
                      184
                      301

                      3200
                      Obligated balance, end of year
                      184
                      301
                      407

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      384
                      422
                      489

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      194
                      225

                      4101
                      Outlays from mandatory balances
                      342
                      151
                      190

                      4110
                      Outlays, gross (total)
                      342
                      345
                      415

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –34

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      6

                      4160
                      Budget authority, net (mandatory)
                      356
                      422
                      489

                      4170
                      Outlays, net (mandatory)
                      308
                      345
                      415

                      4180
                      Budget authority, net (total)
                      356
                      422
                      489

                      4190
                      Outlays, net (total)
                      308
                      345
                      415

             HHS, along with CDC, began implementing provisions of the James Zadroga 9/11 Health and Compensation Act of 2010 (P.L. 111–347)
                on July 1, 2011, to provide monitoring and treatment benefits to eligible responders and survivors. CDC serves as the Program
                Administrator for the World Trade Center (WTC) Health Program. The WTC Health Program provides quality care for WTC-related
                health conditions, conducts WTC research, and maintains a health registry to collect data on victims of the September 11,
                2001, terrorist attacks. The WTC Health Program has been extended through FY 2090 under the James Zadroga 9/11 Health and
                Compensation Reauthorization Act of 2015 (P.L. 114–113, Division O, Title III). The amounts included for 2018 and 2019 in
                the Budget reflect estimated Federal obligations for the WTC Health Program.

          Object Classification (in millions of dollars)

                      Identification code 075–0946–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      3
                      3
                      3

                      11.7
                      Military personnel
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      4
                      4
                      4

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      31
                      43
                      43

                      25.2
                      Other services from non-Federal sources
                      74
                      88
                      97

                      25.3
                      Other goods and services from Federal sources
                      10
                      12
                      12

                      41.0
                      Grants, subsidies, and contributions
                      20
                      24
                      24

                      42.0
                      Insurance claims and indemnities
                      249
                      289
                      339

                      99.9
                      Total new obligations, unexpired accounts
                      390
                      462
                      521

          Employment Summary

                      Identification code 075–0946–0–1–551
                      2017 actual
                      2018 est.
                      2019 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, $3,756,093,000, of which up to $10,000,000 may be used for facilities repairs and improvements at the National Cancer Institute—Frederick Federally Funded Research
                and Development Center in Frederick, Maryland.

             national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
                and blood products, $2,237,268,000.

             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, $297,050,000.

             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, $1,305,132,000.

             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, $1,294,472,000.

             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, $3,423,408,000.

             national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $1,849,515,000, of which $741,000,000 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, $963,045,000.

             national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $511,155,000.

             national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $498,347,000.

             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, $53,967,000.

             national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging, $1,429,335,000.

             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,
                $393,311,000.

             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, $304,812,000.

             national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, $104,847,000.

             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, $337,247,000

             national institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $839,816,000.

             national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,117,682,000.

             national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, $368,785,000.

             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, $249,138,000.

             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, $93,974,000.

             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,
                $201,686,000.

             john e. fogarty international centerFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
                   of the PHS Act), $50,384,000.

             national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, $284,324,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2020: Provided further, That in fiscal year 2019, 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, $492,515,000: Provided, That up to 10 percent of the amount available under this heading 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, $1,338,005,000: 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 $431,924,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act.
          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, $200,000,000, to remain available through September 30, 2023.
             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, $255,960,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2019: 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.
             National Institute for Occupational Safety and Health For 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 Program For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
                   available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative
                   expenses in section 151(b) of division B, title I of Public Law 106–554.
             National Institute on Disability, Independent Living, and Rehabilitation ResearchFor carrying out title II (and section 14 with respect to such title) of the Rehabilitation Act of 1973, $95,127,000.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      Receipts:

                      Current law:

                      1130
                      Cooperative Research and Development Agreements, NIH
                      42
                      42
                      42

                      2000
                      Total: Balances and receipts
                      42
                      42
                      42

                      Appropriations:

                      Current law:

                      2101
                      National Institutes of Health
                      –42
                      –42
                      –42

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      National Cancer Institute (0849)
                      5,637
                      5,353
                      3,756

                      0002
                      National Heart, Lung, and Blood Institute (0872)
                      3,210
                      3,185
                      2,237

                      0003
                      National Institute of Dental and Craniofacial Research (0873)
                      425
                      423
                      297

                      0004
                      National Institute of Diabetes and Digestive and Kidney Disease (0884)
                      1,870
                      1,858
                      1,305

                      0005
                      National Institute of Neurological Disorders and Stroke (0886)
                      1,779
                      1,772
                      1,294

                      0006
                      National Institute of Allergy and Infectious Diseases (0885)
                      5,102
                      4,873
                      3,423

                      0007
                      National Institute of General Medical Sciences (0851)
                      1,822
                      1,814
                      1,109

                      0008
                      National Institute of Child Health and Human Development (0844)
                      1,377
                      1,371
                      963

                      0009
                      National Eye Institute (0887)
                      731
                      728
                      511

                      0010
                      National Institute of Environmental Health Sciences (0862)
                      793
                      709
                      552

                      0011
                      National Institute on Aging (0843)
                      2,049
                      2,035
                      1,429

                      0012
                      National Institute of Arthritis and Musculoskeletal and Skin Disease (0888)
                      557
                      554
                      393

                      0013
                      National Institute on Deafness and Other Communication Disorder (0890)
                      436
                      434
                      305

                      0014
                      National Institute of Mental Health (0892)
                      1,605
                      1,591
                      1,118

                      0015
                      National Institute on Drug Abuse (0893)
                      1,071
                      1,083
                      840

                      0016
                      National Institute on Alcohol Abuse and Alcoholism (0894)
                      482
                      480
                      337

                      0017
                      National Institute of Nursing Research (0889)
                      150
                      149
                      105

                      0018
                      National Human Genome Research Institute (0891)
                      528
                      525
                      369

                      0019
                      National Institute of Biomedical Imaging and Bioengineering (0898)
                      357
                      355
                      249

                      0021
                      National Center for Complementary and Integrative Health (0896)
                      134
                      134
                      94

                      0022
                      National Institute on Minority Health and Health Disparities (0897)
                      288
                      287
                      202

                      0023
                      John E. Fogarty International Center (0819)
                      72
                      72
                      50

                      0024
                      National Library of Medicine (0807)
                      406
                      405
                      284

                      0025
                      NIH Office of the Director (0846)
                      1,676
                      1,654
                      1,338

                      0026
                      NIH Buildings and facilities (0838)
                      113
                      128
                      200

                      0027
                      NIH Cooperative Research and Development Agreements
                      32
                      32
                      32

                      0028
                      National Center for Advancing Translational Sciences (0875)
                      704
                      701
                      493

                      0029
                      National Institute for Research on Safety and Quality

                      256

                      0031
                      Type 1 Diabetes
                      140
                      38
                      150

                      0032
                      National Institute of Occupational Safety and Health

                      200

                      0033
                      National Institute on Disability, Independent Living, and Rehabilitation

                      95

                      0035
                      EEOICPA

                      55

                      0799
                      Total direct obligations
                      33,546
                      32,743
                      24,041

                      0801
                      NIH Reimbursable - Other
                      3,880
                      4,299
                      3,451

                      0802
                      NIH Royalties
                      141
                      141
                      141

                      0809
                      Reimbursable program activities, subtotal
                      4,021
                      4,440
                      3,592

                      0899
                      Total reimbursable obligations
                      4,021
                      4,440
                      3,592

                      0900
                      Total new obligations, unexpired accounts
                      37,567
                      37,183
                      27,633

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,363
                      992
                      495

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1,363
                      992

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      66

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

                      1011
                      Unobligated balance transfer from other acct [075–1700]

                      22

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –8

                      1021
                      Recoveries of prior year unpaid obligations
                      78

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      1,503
                      992
                      517

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      32,973
                      32,748
                      23,805

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –72

                      1121
                      Appropriations transferred from other acct [075–5628]
                      300
                      298
                      515

                      1121
                      Appropriations transferred from other acct [075–5736]
                      13
                      1
                      13

                      1160
                      Appropriation, discretionary (total)
                      33,214
                      33,047
                      24,333

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      150
                      38

                      1201
                      Appropriation (special or trust fund)
                      42
                      42
                      42

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –10

                      1260
                      Appropriations, mandatory (total)
                      182
                      80
                      42

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3,737
                      3,559
                      3,559

                      1701
                      Change in uncollected payments, Federal sources
                      –74

                      1750
                      Spending auth from offsetting collections, disc (total)
                      3,663
                      3,559
                      3,559

                      1900
                      Budget authority (total)
                      37,059
                      36,686
                      27,934

                      1930
                      Total budgetary resources available
                      38,562
                      37,678
                      28,451

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –3

                      1941
                      Unexpired unobligated balance, end of year
                      992
                      495
                      818

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      32,960
                      34,684
                      33,988

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1
                      20

                      3010
                      New obligations, unexpired accounts
                      37,567
                      37,183
                      27,633

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      546

                      3020
                      Outlays (gross)
                      –35,316
                      –37,879
                      –36,029

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –78

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –1,015

                      3050
                      Unpaid obligations, end of year
                      34,684
                      33,988
                      25,592

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –1,207
                      –671
                      –671

                      3061
                      Adjustments to uncollected pymts, Fed sources, brought forward, Oct 1
                      8

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      74

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      454

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –671
                      –671
                      –671

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      31,781
                      34,013
                      33,317

                      3200
                      Obligated balance, end of year
                      34,013
                      33,317
                      24,921

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      36,877
                      36,606
                      27,892

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      11,344
                      12,482
                      11,544

                      4011
                      Outlays from discretionary balances
                      23,809
                      25,237
                      24,389

                      4020
                      Outlays, gross (total)
                      35,153
                      37,719
                      35,933

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –3,950
                      –3,559
                      –3,559

                      4033
                      Non-Federal sources
                      –304

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,254
                      –3,559
                      –3,559

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      74

                      4052
                      Offsetting collections credited to expired accounts
                      516

                      4053
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4060
                      Additional offsets against budget authority only (total)
                      591

                      4070
                      Budget authority, net (discretionary)
                      33,214
                      33,047
                      24,333

                      4080
                      Outlays, net (discretionary)
                      30,899
                      34,160
                      32,374

                      Mandatory:

                      4090
                      Budget authority, gross
                      182
                      80
                      42

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      22
                      51
                      42

                      4101
                      Outlays from mandatory balances
                      141
                      109
                      54

                      4110
                      Outlays, gross (total)
                      163
                      160
                      96

                      4180
                      Budget authority, net (total)
                      33,396
                      33,127
                      24,375

                      4190
                      Outlays, net (total)
                      31,062
                      34,320
                      32,470

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      33,396
                      33,127
                      24,375

                      Outlays
                      31,062
                      34,320
                      32,470

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      113
                      150

                      Outlays

                      12
                      56

                      Total:

                      Budget Authority
                      33,396
                      33,240
                      24,525

                      Outlays
                      31,062
                      34,332
                      32,526

             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 2019 Budget consolidates
                the activities of the Agency for Healthcare Research and Quality within the National Institutes of Health as the National
                Institute for Research on Safety and Quality. It also consolidates the National Institute for Occupational Safety and Health
                (currently administered by the Centers for Disease Control and Prevention) and the National Institute on Disability, Independent
                Living, and Rehabilitation Research (currently administered by the Administration for Community Living) within the National
                Institutes of Health. Detailed information is available through the Department of Health and Human Services.

          Object Classification (in millions of dollars)

                      Identification code 075–9915–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      976
                      1,007
                      1,181

                      11.3
                      Other than full-time permanent
                      520
                      529
                      535

                      11.5
                      Other personnel compensation
                      46
                      46
                      45

                      11.7
                      Military personnel
                      18
                      19
                      20

                      11.8
                      Special personal services payments
                      176
                      177
                      158

                      11.9
                      Total personnel compensation
                      1,736
                      1,778
                      1,939

                      12.1
                      Civilian personnel benefits
                      506
                      518
                      536

                      12.2
                      Military personnel benefits
                      12
                      12
                      13

                      21.0
                      Travel and transportation of persons
                      51
                      51
                      22

                      22.0
                      Transportation of things
                      5
                      5
                      2

                      23.1
                      Rental payments to GSA
                      23
                      24
                      8

                      23.2
                      Rental payments to others
                      1
                      1
                      1

                      23.3
                      Communications, utilities, and miscellaneous charges
                      31
                      31
                      19

                      24.0
                      Printing and reproduction
                      1
                      1

                      25.1
                      Advisory and assistance services
                      231
                      200
                      100

                      25.2
                      Other services from non-Federal sources
                      1,445
                      1,189
                      614

                      25.3
                      Other goods and services from Federal sources
                      3,177
                      3,186
                      2,669

                      25.4
                      Operation and maintenance of facilities
                      201
                      208
                      368

                      25.5
                      Research and development contracts
                      1,534
                      1,402
                      1,012

                      25.6
                      Medical care
                      26
                      25
                      11

                      25.7
                      Operation and maintenance of equipment
                      122
                      121
                      51

                      25.8
                      Subsistence and support of persons
                      2
                      2
                      1

                      26.0
                      Supplies and materials
                      231
                      219
                      67

                      31.0
                      Equipment
                      154
                      147
                      50

                      41.0
                      Grants, subsidies, and contributions
                      24,057
                      23,623
                      16,558

                      99.0
                      Direct obligations
                      33,546
                      32,743
                      24,041

                      99.0
                      Reimbursable obligations
                      4,021
                      4,440
                      3,592

                      99.9
                      Total new obligations, unexpired accounts
                      37,567
                      37,183
                      27,633

          Employment Summary

                      Identification code 075–9915–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      13,251
                      13,314
                      14,571

                      1101
                      Direct military average strength employment
                      167
                      168
                      260

                      2001
                      Reimbursable civilian full-time equivalent employment
                      4,506
                      4,529
                      4,531

                      2101
                      Reimbursable military average strength employment
                      90
                      90
                      90

             National Institutes of Health

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

                      Identification code 075–9915–4–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0031
                      Type 1 Diabetes

                      113
                      150

                      0799
                      Total direct obligations

                      113
                      150

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

                      113
                      150

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      113
                      150

                      1930
                      Total budgetary resources available

                      113
                      150

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      101

                      3010
                      New obligations, unexpired accounts

                      113
                      150

                      3020
                      Outlays (gross)

                      –12
                      –56

                      3050
                      Unpaid obligations, end of year

                      101
                      195

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      101

                      3200
                      Obligated balance, end of year

                      101
                      195

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      113
                      150

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      12
                      15

                      4101
                      Outlays from mandatory balances

                      41

                      4110
                      Outlays, gross (total)

                      12
                      56

                      4180
                      Budget authority, net (total)

                      113
                      150

                      4190
                      Outlays, net (total)

                      12
                      56

             The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through fiscal year 2019.

             Payment to the NIH Innovation Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0147–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Payment to NIH Innovation (object class 94.0)
                      352
                      496
                      711

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      352
                      496
                      711

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      352
                      496
                      711

                      1930
                      Total budgetary resources available
                      352
                      496
                      711

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      352
                      496
                      711

                      3020
                      Outlays (gross)
                      –352
                      –496
                      –711

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      352
                      496
                      711

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      352
                      496
                      711

                      4180
                      Budget authority, net (total)
                      352
                      496
                      711

                      4190
                      Outlays, net (total)
                      352
                      496
                      711

             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, $711,000,000, 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, $400,000,000 shall be transferred to the "National Cancer Institute" for the purposes described in section 1001(b)(4)(C) of such Act,
                $57,500,000 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 $57,500,000 shall be transferred to the "National Institute of Mental Health" for the purposes described in section 1001(b)(4)(B) of
                such Act: Provided further, That remaining amounts may be transferred by the Director of the National Institutes of Health to any accounts of the National
                Institutes of Health: Provided further, That upon a determination by the Director that funds transferred pursuant to any of the previous provisos are not necessary
                for the purposes provided, such amounts may be transferred back to this account: Provided further, That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      146

                      Receipts:

                      Current law:

                      1140
                      General Fund Payment, NIH Innovation, CURES Act
                      352
                      496
                      711

                      2000
                      Total: Balances and receipts
                      352
                      496
                      857

                      Appropriations:

                      Current law:

                      2101
                      NIH Innovation, Cures Act
                      –352
                      –350
                      –711

                      5099
                      Balance, end of year

                      146
                      146

          Program and Financing (in millions of dollars)

                      Identification code 075–5628–0–2–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      CURES obligations
                      12
                      52
                      196

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      12
                      52
                      196

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      40
                      40

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      352
                      350
                      711

                      1120
                      Appropriations transferred to other acct [075–9915]
                      –300
                      –298
                      –515

                      1160
                      Appropriation, discretionary (total)
                      52
                      52
                      196

                      1930
                      Total budgetary resources available
                      52
                      92
                      236

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      40
                      40
                      40

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      12
                      27

                      3010
                      New obligations, unexpired accounts
                      12
                      52
                      196

                      3020
                      Outlays (gross)

                      –37
                      –81

                      3050
                      Unpaid obligations, end of year
                      12
                      27
                      142

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      12
                      27

                      3200
                      Obligated balance, end of year
                      12
                      27
                      142

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      52
                      52
                      196

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority

                      12
                      47

                      4011
                      Outlays from discretionary balances

                      25
                      34

                      4020
                      Outlays, gross (total)

                      37
                      81

                      4180
                      Budget authority, net (total)
                      52
                      52
                      196

                      4190
                      Outlays, net (total)

                      37
                      81

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

             10-Year Pediatric Research Initiative Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      13

                      Receipts:

                      Current law:

                      1140
                      Transfers from Presidential Election Campaign Fund

                      1
                      41

                      2000
                      Total: Balances and receipts
                      13
                      1
                      41

                      Appropriations:

                      Current law:

                      2101
                      10-Year Pediatric Research Initiative Fund
                      –13
                      –1
                      –13

                      5099
                      Balance, end of year

                      28

          Program and Financing (in millions of dollars)

                      Identification code 075–5736–0–2–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      13
                      1
                      13

                      1120
                      Appropriations transferred to other accts [075–9915]
                      –13
                      –1
                      –13

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Substance Abuse and Mental Health Services Administration

             Federal Funds
             MENTAL HEALTHFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
                Individuals with Mental Illness Act, $1,043,883,000: Provided, That notwithstanding section 520A(f)(2) of the PHS Act, no funds appropriated for carrying out section 520A shall be available
                for carrying out section 1971 of the PHS Act: Provided further, That in addition to amounts provided herein, $21,039,000 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, $15,000,000 shall be to carry out section 224 of the Protecting Access to Medicare Act of 2014 (Public Law 113–93; 42 U.S.C. 290aa 22
                note).

             SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
                respect to substance abuse treatment and prevention, $2,034,197,000: Provided, That in addition to amounts provided herein, $79,200,000 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 and for the Drug-Free Communities Support Program authorized by the Drug-Free Communities Act of 1997, as amended, $220,885,000, of which $2,000,000 shall be made available as directed by section 4 of Public Law 107–82, as amended by Public
                   Law 109–469 (21 U.S.C. 1521 note) and $3,000,000, to remain available until expended, shall be for activities authorized by
                   section 103 of Public Law 114–198.

             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, the Drug-Free Communities Act of 1997, as amended, and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services
                Administration ("SAMHSA"), $126,922,000: Provided, That in addition to amounts provided herein, $20,426,000 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, 2020: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings
                "Mental Health", "Substance Abuse Treatment", and "Substance Abuse Prevention": Provided further, That the Assistant Secretary for Mental Health and Substance Use may transfer discretionary funds (pursuant to the Balanced
                Budget and Emergency Deficit Control Act of 1985) which are appropriated for the current fiscal year for SAMHSA in this Act
                between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at
                least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1362–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0006
                      Mental Health
                      1,145
                      1,140
                      1,044

                      0007
                      Substance Abuse Treatment
                      2,627
                      2,613
                      2,034

                      0008
                      Substance Abuse Prevention
                      222
                      222
                      221

                      0009
                      Health Surveillance and Program Support
                      117
                      116
                      127

                      0011
                      SAMHSA Prevention Fund
                      12
                      11

                      0100
                      Total, direct program
                      4,123
                      4,102
                      3,426

                      0799
                      Total direct obligations
                      4,123
                      4,102
                      3,426

                      0802
                      SAMHSA Reimbursables
                      108
                      108
                      19

                      0810
                      SAMHSA Reimbursable:  PHS Evaluation
                      134
                      133
                      121

                      0899
                      Total reimbursable obligations
                      242
                      241
                      140

                      0900
                      Total new obligations, unexpired accounts
                      4,365
                      4,343
                      3,566

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      3
                      13

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      1

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1

                      10

                      1050
                      Unobligated balance (total)
                      1
                      13
                      13

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,619
                      3,594
                      3,426

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –8

                      1121
                      Appropriations transferred from other acct [075–5627]
                      500
                      497

                      1121
                      Appropriations transferred from other acct [075–0116]

                      11

                      1160
                      Appropriation, discretionary (total)
                      4,111
                      4,102
                      3,426

                      Appropriations, mandatory:

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

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      153
                      160
                      137

                      1701
                      Change in uncollected payments, Federal sources
                      91
                      81

                      1750
                      Spending auth from offsetting collections, disc (total)
                      244
                      241
                      137

                      1900
                      Budget authority (total)
                      4,367
                      4,343
                      3,563

                      1930
                      Total budgetary resources available
                      4,368
                      4,356
                      3,576

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3
                      13
                      10

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3,977
                      4,506
                      4,476

                      3010
                      New obligations, unexpired accounts
                      4,365
                      4,343
                      3,566

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      18

                      3020
                      Outlays (gross)
                      –3,759
                      –4,047
                      –3,753

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –95
                      –326

                      3050
                      Unpaid obligations, end of year
                      4,506
                      4,476
                      4,289

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –245
                      –143
                      –224

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –91
                      –81

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      193

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –143
                      –224
                      –224

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3,732
                      4,363
                      4,252

                      3200
                      Obligated balance, end of year
                      4,363
                      4,252
                      4,065

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,355
                      4,343
                      3,563

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,144
                      1,118
                      993

                      4011
                      Outlays from discretionary balances
                      2,579
                      2,921
                      2,759

                      4020
                      Outlays, gross (total)
                      3,723
                      4,039
                      3,752

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –344
                      –311
                      –135

                      4033
                      Non-Federal sources
                      –1
                      –2
                      –2

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –345
                      –313
                      –137

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –91
                      –81

                      4052
                      Offsetting collections credited to expired accounts
                      192
                      153

                      4060
                      Additional offsets against budget authority only (total)
                      101
                      72

                      4070
                      Budget authority, net (discretionary)
                      4,111
                      4,102
                      3,426

                      4080
                      Outlays, net (discretionary)
                      3,378
                      3,726
                      3,615

                      Mandatory:

                      4090
                      Budget authority, gross
                      12

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      36
                      8
                      1

                      4180
                      Budget authority, net (total)
                      4,123
                      4,102
                      3,426

                      4190
                      Outlays, net (total)
                      3,414
                      3,734
                      3,616

             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 organizations, and private not-for-profit
                organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.

          Object Classification (in millions of dollars)

                      Identification code 075–1362–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      46
                      50
                      52

                      11.3
                      Other than full-time permanent
                      2
                      3
                      3

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.7
                      Military personnel
                      3
                      4
                      4

                      11.9
                      Total personnel compensation
                      52
                      58
                      60

                      12.1
                      Civilian personnel benefits
                      16
                      17
                      18

                      12.2
                      Military personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      2
                      2
                      2

                      23.1
                      Rental payments to GSA
                      7
                      7
                      7

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      24.0
                      Printing and reproduction
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      29
                      31
                      31

                      25.2
                      Other services from non-Federal sources
                      191
                      179
                      196

                      25.3
                      Other goods and services from Federal sources
                      45
                      47
                      48

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      3,775
                      3,755
                      3,058

                      99.0
                      Direct obligations
                      4,123
                      4,102
                      3,426

                      99.0
                      Reimbursable obligations
                      242
                      241
                      140

                      99.9
                      Total new obligations, unexpired accounts
                      4,365
                      4,343
                      3,566

          Employment Summary

                      Identification code 075–1362–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      451
                      475
                      475

                      1101
                      Direct military average strength employment
                      31
                      31
                      31

                      2001
                      Reimbursable civilian full-time equivalent employment
                      101
                      101
                      71

                      2101
                      Reimbursable military average strength employment
                      7
                      7
                      7

             Agency for Healthcare Research and Quality

             Federal Funds
             Healthcare research and quality
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Research on Health Costs, Quality and Outcomes
                      186
                      186

                      0002
                      Medical Expenditure Panel Survey
                      66
                      66

                      0003
                      AHRQ Program Support
                      71
                      70

                      0799
                      Total direct obligations
                      323
                      322

                      0803
                      Research on Health Costs, Quality and Outcomes (Reimbursable)
                      16
                      16

                      0804
                      Medical Expenditure Panel Survey (Reimbursable)
                      1
                      1

                      0805
                      AHRQ Program Support (Reimbursable)
                      1
                      1

                      0899
                      Total reimbursable obligations
                      18
                      18

                      0900
                      Total new obligations, unexpired accounts
                      341
                      340

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      16
                      23
                      22

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      16
                      23

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

                      –22

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1

                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1050
                      Unobligated balance (total)
                      18
                      24

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      324
                      322

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –1

                      1160
                      Appropriation, discretionary (total)
                      323
                      322

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1

                      1701
                      Change in uncollected payments, Federal sources
                      15
                      8

                      1750
                      Spending auth from offsetting collections, disc (total)
                      16
                      8

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      7
                      8

                      1900
                      Budget authority (total)
                      346
                      338

                      1930
                      Total budgetary resources available
                      364
                      362

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      23
                      22

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      383
                      345
                      377

                      3010
                      New obligations, unexpired accounts
                      341
                      340

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

                      3020
                      Outlays (gross)
                      –365
                      –308
                      –240

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –13

                      3050
                      Unpaid obligations, end of year
                      345
                      377
                      137

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –85
                      –53
                      –61

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –15
                      –8

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      47

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –53
                      –61
                      –61

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      298
                      292
                      316

                      3200
                      Obligated balance, end of year
                      292
                      316
                      76

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      339
                      330

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      134
                      121

                      4011
                      Outlays from discretionary balances
                      224
                      183
                      240

                      4020
                      Outlays, gross (total)
                      358
                      304
                      240

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –40

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –40

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –15
                      –8

                      4052
                      Offsetting collections credited to expired accounts
                      39

                      4060
                      Additional offsets against budget authority only (total)
                      24
                      –8

                      4070
                      Budget authority, net (discretionary)
                      323
                      322

                      4080
                      Outlays, net (discretionary)
                      318
                      304
                      240

                      Mandatory:

                      4090
                      Budget authority, gross
                      7
                      8

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1

                      4101
                      Outlays from mandatory balances
                      7
                      3

                      4110
                      Outlays, gross (total)
                      7
                      4

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –7
                      –8

                      4180
                      Budget authority, net (total)
                      323
                      322

                      4190
                      Outlays, net (total)
                      318
                      300
                      240

             The FY 2019 Budget consolidates the activities of the Agency for Healthcare Research and Quality within the National Institutes
                of Health as the National Institute for Research on Safety and Quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1700–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      30
                      33

                      11.3
                      Other than full-time permanent
                      4
                      3

                      11.5
                      Other personnel compensation
                      1
                      1

                      11.7
                      Military personnel
                      1
                      1

                      11.9
                      Total personnel compensation
                      36
                      38

                      12.1
                      Civilian personnel benefits
                      11
                      10

                      12.2
                      Military personnel benefits

                      1

                      23.1
                      Rental payments to GSA
                      3
                      4

                      23.3
                      Communications, utilities, and miscellaneous charges

                      1

                      25.2
                      Other services from non-Federal sources
                      12
                      15

                      25.3
                      Other goods and services from Federal sources
                      22
                      19

                      25.5
                      Research and development contracts
                      134
                      130

                      31.0
                      Equipment
                      1
                      2

                      41.0
                      Grants, subsidies, and contributions
                      104
                      102

                      99.0
                      Direct obligations
                      323
                      322

                      99.0
                      Reimbursable obligations
                      18
                      18

                      99.9
                      Total new obligations, unexpired accounts
                      341
                      340

          Employment Summary

                      Identification code 075–1700–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      273
                      270

                      1101
                      Direct military average strength employment
                      7
                      7

                      2001
                      Reimbursable civilian full-time equivalent employment
                      2
                      2

                      3001
                      Allocation account civilian full-time equivalent employment
                      8
                      8

             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, $276,236,212,000, to remain available until expended.
          In addition, for carrying out such titles after May 31, 2019, for the last quarter of fiscal year 2019 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 2020, $137,931,797,000, to remain available until expended.
          Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such
                quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0512–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments
                      394,370
                      407,290
                      433,103

                      0002
                      State and local administration
                      22,596
                      20,960
                      21,475

                      0003
                      Vaccines for Children
                      4,427
                      4,401
                      4,726

                      0799
                      Total direct obligations
                      421,393
                      432,651
                      459,304

                      0801
                      Medicare Part B premiums
                      652
                      1,000
                      1,054

                      0802
                      Medicare Part D

                      3
                      4

                      0899
                      Total reimbursable obligations
                      652
                      1,003
                      1,058

                      0900
                      Total new obligations, unexpired accounts
                      422,045
                      433,654
                      460,362

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      413
                      309
                      11,545

                      1021
                      Recoveries of prior year unpaid obligations
                      34,566
                      33,870
                      36,675

                      1029
                      Other balances withdrawn to Treasury
                      –15,728

                      1033
                      Recoveries of prior year paid obligations
                      12,812

                      1050
                      Unobligated balance (total)
                      32,063
                      34,179
                      48,220

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      273,767
                      284,798
                      276,236

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      115,583
                      125,219
                      134,848

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      652
                      1,003
                      1,058

                      1801
                      Change in uncollected payments, Federal sources
                      289

                      1850
                      Spending auth from offsetting collections, mand (total):
                      941
                      1,003
                      1,058

                      1900
                      Budget authority (total)
                      390,291
                      411,020
                      412,142

                      1930
                      Total budgetary resources available
                      422,354
                      445,199
                      460,362

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      309
                      11,545

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      40,649
                      39,982
                      36,675

                      3010
                      New obligations, unexpired accounts
                      422,045
                      433,654
                      460,362

                      3020
                      Outlays (gross)
                      –388,146
                      –403,091
                      –421,300

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –34,566
                      –33,870
                      –36,675

                      3050
                      Unpaid obligations, end of year
                      39,982
                      36,675
                      39,062

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –105
                      –394
                      –394

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –289

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –394
                      –394
                      –394

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      40,544
                      39,588
                      36,281

                      3200
                      Obligated balance, end of year
                      39,588
                      36,281
                      38,668

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      390,291
                      411,020
                      412,142

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      356,275
                      363,110
                      412,142

                      4101
                      Outlays from mandatory balances
                      31,871
                      39,981
                      9,158

                      4110
                      Outlays, gross (total)
                      388,146
                      403,091
                      421,300

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –652
                      –1,003
                      –1,058

                      4123
                      Non-Federal sources
                      –12,812

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –13,464
                      –1,003
                      –1,058

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –289

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      12,812

                      4150
                      Additional offsets against budget authority only (total)
                      12,523

                      4160
                      Budget authority, net (mandatory)
                      389,350
                      410,017
                      411,084

                      4170
                      Outlays, net (mandatory)
                      374,682
                      402,088
                      420,242

                      4180
                      Budget authority, net (total)
                      389,350
                      410,017
                      411,084

                      4190
                      Outlays, net (total)
                      374,682
                      402,088
                      420,242

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      389,350
                      410,017
                      411,084

                      Outlays
                      374,682
                      402,088
                      420,242

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,700
                      –8,209

                      Outlays

                      –1,700
                      –8,209

                      Total:

                      Budget Authority
                      389,350
                      408,317
                      402,875

                      Outlays
                      374,682
                      400,388
                      412,033

             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
                         2017
                         2018
                         2019

                         Vaccine Purchase
                         4,241
                         4,193
                         4,427

                         Vaccine Stockpile
                         14
                         27
                         112

                         Ordering, Distribution, and Operations
                         133
                         130
                         136

                         Vaccine Management Contract Support
                         0
                         0
                         0

                         Evaluation Activities
                         50
                         51
                         52

                         Total Obligations
                         4,437
                         4,401
                         4,726

          Object Classification (in millions of dollars)

                      Identification code 075–0512–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      41.0
                      Direct obligations: Grants, subsidies, and contributions
                      421,393
                      432,651
                      459,304

                      99.0
                      Reimbursable obligations
                      652
                      1,003
                      1,058

                      99.9
                      Total new obligations, unexpired accounts
                      422,045
                      433,654
                      460,362

             Grants to States for Medicaid

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

                      Identification code 075–0512–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Medicaid Vendor Payments

                      –1,700
                      –8,209

                      0799
                      Total direct obligations

                      –1,700
                      –8,209

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

                      –1,700
                      –8,209

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,700
                      –8,209

                      1900
                      Budget authority (total)

                      –1,700
                      –8,209

                      1930
                      Total budgetary resources available

                      –1,700
                      –8,209

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,700
                      –8,209

                      3020
                      Outlays (gross)

                      1,700
                      8,209

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,700
                      –8,209

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,700
                      –8,209

                      4180
                      Budget authority, net (total)

                      –1,700
                      –8,209

                      4190
                      Outlays, net (total)

                      –1,700
                      –8,209

             This schedule reflects the Administration's Medicaid proposals.

             State Grants and Demonstrations

             Program and Financing (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0011
                      Emergency health services for undocumented aliens
                      1

                      0012
                      Medicaid integrity program
                      92
                      86
                      87

                      0023
                      Grants to improve outreach and enrollment
                      18

                      0799
                      Total direct obligations
                      111
                      86
                      87

                      0900
                      Total new obligations, unexpired accounts
                      111
                      86
                      87

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1,006
                      244
                      238

                      1021
                      Recoveries of prior year unpaid obligations
                      32

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      1,039
                      244
                      238

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      84
                      86
                      87

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

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –760

                      1260
                      Appropriations, mandatory (total)
                      –682
                      80
                      87

                      1900
                      Budget authority (total)
                      –682
                      80
                      87

                      1930
                      Total budgetary resources available
                      357
                      324
                      325

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –2

                      1941
                      Unexpired unobligated balance, end of year
                      244
                      238
                      238

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,721
                      1,297
                      800

                      3010
                      New obligations, unexpired accounts
                      111
                      86
                      87

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      4

                      3020
                      Outlays (gross)
                      –503
                      –583
                      –578

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –32

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –4

                      3050
                      Unpaid obligations, end of year
                      1,297
                      800
                      309

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,721
                      1,297
                      800

                      3200
                      Obligated balance, end of year
                      1,297
                      800
                      309

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      –682
                      80
                      87

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      7
                      6
                      14

                      4101
                      Outlays from mandatory balances
                      496
                      577
                      564

                      4110
                      Outlays, gross (total)
                      503
                      583
                      578

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4160
                      Budget authority, net (mandatory)
                      –682
                      80
                      87

                      4170
                      Outlays, net (mandatory)
                      502
                      583
                      578

                      4180
                      Budget authority, net (total)
                      –682
                      80
                      87

                      4190
                      Outlays, net (total)
                      502
                      583
                      578

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

          Object Classification (in millions of dollars)

                      Identification code 075–0516–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent - Medicaid Integrity Program
                      10
                      12
                      12

                      12.1
                      Civilian personnel benefits - Medicaid Integrity Program
                      5
                      6
                      6

                      41.0
                      Grants, subsidies, and contributions - Emergency services for undocumented aliens
                      1

                      41.0
                      Grants, subsidies, and contributions - Medicaid Integrity Program
                      77
                      68
                      69

                      41.0
                      Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                      18

                      99.0
                      Direct obligations
                      111
                      86
                      87

                      99.9
                      Total new obligations, unexpired accounts
                      111
                      86
                      87

          Employment Summary

                      Identification code 075–0516–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      91
                      207
                      207

             Payments to health care trust fundsFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
                under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
                of 1965, section 278(d)(3) of Public Law 97–248, and for administrative expenses incurred pursuant to section 201(g) of the
                Social Security Act, $378,343,800,000.
          In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
                Act that were not anticipated in budget estimates, such sums as may be necessary.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0580–0–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)
                      229,733
                      262,496
                      284,288

                      0002
                      Part D benefits (Rx Drug)
                      82,382
                      88,133
                      92,070

                      0003
                      Part D Federal administration (Rx Drug)
                      405
                      422
                      642

                      0004
                      General Fund Transfers to HI
                      1,293
                      1,543
                      1,339

                      0006
                      Federal Bureau of Investigation (HCFAC)
                      131
                      135
                      147

                      0007
                      Federal payments from taxation of OASDI benefits (HI)
                      24,206
                      23,684
                      24,943

                      0008
                      Criminal fines (HCFAC)
                      12
                      109
                      150

                      0009
                      Civil penalties and damages (HCFAC—DOJ and CMS administration)
                      46
                      51
                      52

                      0010
                      Asset Forfeiture
                      25
                      30
                      31

                      0011
                      State Low Income Determinations
                      3
                      3
                      4

                      0900
                      Total new obligations, unexpired accounts
                      338,236
                      376,606
                      403,666

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1,928

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)
                      313,816
                      352,597
                      378,323

                      1200
                      Appropriation (indefinite, permanent)
                      24,206
                      25,612
                      29,065

                      1200
                      Appropriation (HCFAC for FBI)
                      131
                      135
                      147

                      1200
                      Appropriation (indefinite for HCFAC)
                      83
                      190
                      254

                      1260
                      Appropriations, mandatory (total)
                      338,236
                      378,534
                      407,789

                      1930
                      Total budgetary resources available
                      338,236
                      378,534
                      409,717

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      1,928
                      6,051

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      27,070
                      18,743
                      52,991

                      3010
                      New obligations, unexpired accounts
                      338,236
                      376,606
                      403,666

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      1,306

                      3020
                      Outlays (gross)
                      –335,137
                      –342,358
                      –364,182

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –12,732

                      3050
                      Unpaid obligations, end of year
                      18,743
                      52,991
                      92,475

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      27,070
                      18,743
                      52,991

                      3200
                      Obligated balance, end of year
                      18,743
                      52,991
                      92,475

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      338,236
                      378,534
                      407,789

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      324,303
                      324,552
                      336,360

                      4101
                      Outlays from mandatory balances
                      10,834
                      17,806
                      27,822

                      4110
                      Outlays, gross (total)
                      335,137
                      342,358
                      364,182

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –931

                      4123
                      Non-Federal sources
                      –1,306

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –2,237

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      2,237

                      4160
                      Budget authority, net (mandatory)
                      338,236
                      378,534
                      407,789

                      4170
                      Outlays, net (mandatory)
                      332,900
                      342,358
                      364,182

                      4180
                      Budget authority, net (total)
                      338,236
                      378,534
                      407,789

                      4190
                      Outlays, net (total)
                      332,900
                      342,358
                      364,182

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      338,236
                      378,534
                      407,789

                      Outlays
                      332,900
                      342,358
                      364,182

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –39
                      –2,328

                      Outlays

                      –39
                      –2,328

                      Total:

                      Budget Authority
                      338,236
                      378,495
                      405,461

                      Outlays
                      332,900
                      342,319
                      361,854

             Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general
                fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries, and administrative expenses that are
                properly chargeable to the general fund.

          Object Classification (in millions of dollars)

                      Identification code 075–0580–0–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      41.0
                      Grants, subsidies, and contributions
                      336,507
                      374,641
                      401,684

                      42.0
                      Insurance claims and indemnities (HI Uninsured Federal)
                      147
                      132
                      127

                      94.0
                      Financial transfers (Federal admin)
                      1,582
                      1,833
                      1,855

                      99.9
                      Total new obligations, unexpired accounts
                      338,236
                      376,606
                      403,666

             Payments to Health Care Trust Funds

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

                      Identification code 075–0580–2–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Federal contribution to match premiums (SMI)

                      –2,484

                      0002
                      Part D benefits (Rx Drug)

                      –39
                      156

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

                      –39
                      –2,328

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (definite, annual)

                      –39
                      –2,328

                      1930
                      Total budgetary resources available

                      –39
                      –2,328

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –39
                      –2,328

                      3020
                      Outlays (gross)

                      39
                      2,328

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –39
                      –2,328

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –39
                      –2,328

                      4180
                      Budget authority, net (total)

                      –39
                      –2,328

                      4190
                      Outlays, net (total)

                      –39
                      –2,328

             Quality Improvement Organizations

             Program and Financing (in millions of dollars)

                      Identification code 075–0519–0–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      QIO contracts
                      397
                      603
                      1,297

                      0002
                      QIO support contracts
                      180
                      171
                      155

                      0900
                      Total new obligations, unexpired accounts
                      577
                      774
                      1,452

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      124
                      774
                      1,452

                      1801
                      Change in uncollected payments, Federal sources
                      491

                      1850
                      Spending auth from offsetting collections, mand (total)
                      615
                      774
                      1,452

                      1930
                      Total budgetary resources available
                      615
                      774
                      1,452

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –38

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,519
                      1,187
                      1,187

                      3010
                      New obligations, unexpired accounts
                      577
                      774
                      1,452

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

                      3020
                      Outlays (gross)
                      –883
                      –774
                      –1,452

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –27

                      3050
                      Unpaid obligations, end of year
                      1,187
                      1,187
                      1,187

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –2,488
                      –1,983
                      –1,983

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –491

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      996

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –1,983
                      –1,983
                      –1,983

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –969
                      –796
                      –796

                      3200
                      Obligated balance, end of year
                      –796
                      –796
                      –796

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      615
                      774
                      1,452

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      137
                      118
                      972

                      4101
                      Outlays from mandatory balances
                      746
                      656
                      480

                      4110
                      Outlays, gross (total)
                      883
                      774
                      1,452

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –957
                      –774
                      –1,452

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –491

                      4142
                      Offsetting collections credited to expired accounts
                      833

                      4150
                      Additional offsets against budget authority only (total)
                      342

                      4170
                      Outlays, net (mandatory)
                      –74

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –74

                      Memorandum (non-add) entries:

                      5093
                      Expired unavailable balance, SOY: Offsetting collections
                      50
                      50
                      50

                      5095
                      Expired unavailable balance, EOY: Offsetting collections
                      50
                      50
                      50

             Part B of title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982, provides the statutory
                authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to promote the effectiveness,
                efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure that those services are reasonable
                and necessary. The program is funded through transfers from the Medicare Hospital Insurance Trust Fund and the Medicare Supplementary
                Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO program was established to improve budgetary
                operations.

          Object Classification (in millions of dollars)

                      Identification code 075–0519–0–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      34
                      34
                      34

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      3

                      25.2
                      Other services from non-Federal sources
                      511
                      699
                      1,336

                      25.3
                      Other goods and services from Federal sources
                      20
                      26
                      51

                      25.4
                      Operation and maintenance of facilities
                      11
                      14
                      28

                      99.9
                      Total new obligations, unexpired accounts
                      577
                      774
                      1,452

          Employment Summary

                      Identification code 075–0519–0–1–571
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      229
                      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 $3,343,879,000, 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 2019 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations
                with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0511–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Program operations
                      3,094
                      3,172
                      2,422

                      0002
                      Federal administration
                      762
                      775
                      733

                      0003
                      State survey and certification
                      409
                      425
                      444

                      0004
                      Research, demonstrations, and evaluation projects
                      58
                      85
                      29

                      0007
                      ARRA Medicare/Medicaid HIT
                      56
                      123
                      23

                      0008
                      Risk Corridor
                      3,953

                      0100
                      Total direct program
                      8,332
                      4,580
                      3,651

                      0799
                      Total direct obligations
                      8,332
                      4,580
                      3,651

                      0801
                      Clinical laboratory improvement amendments
                      50
                      47
                      50

                      0802
                      Sale of data
                      12
                      20
                      20

                      0803
                      Coordination of benefits
                      34
                      28
                      30

                      0804
                      Medicare advantage/Prescription drug plan
                      80
                      81
                      83

                      0805
                      Provider enrollment
                      18
                      24
                      24

                      0806
                      Recovery audit contractors
                      89
                      285
                      572

                      0808
                      Marketplace User Fees
                      1,126
                      1,212
                      962

                      0810
                      Risk Adjustment Administrative Expenses
                      22
                      19
                      38

                      0813
                      Other reimbursable program activity
                      209
                      15
                      16

                      0899
                      Total reimbursable obligations
                      1,640
                      1,731
                      1,795

                      0900
                      Total new obligations, unexpired accounts
                      9,972
                      6,311
                      5,446

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      –5,575
                      –9,239
                      1,871

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1
                      –500
                      –129

                      1021
                      Recoveries of prior year unpaid obligations
                      97

                      1033
                      Recoveries of prior year paid obligations
                      8

                      1050
                      Unobligated balance (total)
                      –5,970
                      –9,368
                      1,871

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3
                      12,303
                      3

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      –812

                      1260
                      Appropriations, mandatory (total)
                      3
                      11,491
                      3

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,973
                      3,993
                      3,378

                      1701
                      Change in uncollected payments, Federal sources
                      2,372

                      1750
                      Spending auth from offsetting collections, disc (total)
                      4,345
                      3,993
                      3,378

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1,931
                      2,041
                      1,919

                      1801
                      Change in uncollected payments, Federal sources
                      386

                      1802
                      Offsetting collections (previously unavailable)
                      86
                      25
                      103

                      1823
                      New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                      –8

                      1850
                      Spending auth from offsetting collections, mand (total)
                      2,395
                      2,066
                      2,022

                      1900
                      Budget authority (total)
                      6,743
                      17,550
                      5,403

                      1930
                      Total budgetary resources available
                      773
                      8,182
                      7,274

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –40

                      1941
                      Unexpired unobligated balance, end of year
                      –9,239
                      1,871
                      1,828

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      12,072
                      16,607
                      4,895

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1
                      536
                      25

                      3010
                      New obligations, unexpired accounts
                      9,972
                      6,311
                      5,446

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      421

                      3020
                      Outlays (gross)
                      –6,066
                      –18,048
                      –5,683

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –97

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –231

                      3050
                      Unpaid obligations, end of year
                      16,607
                      4,895
                      4,658

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –5,470
                      –6,083
                      –6,083

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,758

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      2,145

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –6,083
                      –6,083
                      –6,083

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,138
                      10,549
                      –1,188

                      3200
                      Obligated balance, end of year
                      10,524
                      –1,188
                      –1,425

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      4,345
                      3,993
                      3,378

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,906
                      3,993
                      3,378

                      4011
                      Outlays from discretionary balances
                      2,388

                      4020
                      Outlays, gross (total)
                      4,294
                      3,993
                      3,378

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –4,161
                      –3,973
                      –3,344

                      4033
                      Non-Federal sources
                      –126
                      –20
                      –34

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –4,287
                      –3,993
                      –3,378

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –2,372

                      4052
                      Offsetting collections credited to expired accounts
                      2,314

                      4060
                      Additional offsets against budget authority only (total)
                      –58

                      4080
                      Outlays, net (discretionary)
                      7

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,398
                      13,557
                      2,025

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      548
                      2,115
                      1,953

                      4101
                      Outlays from mandatory balances
                      1,224
                      11,940
                      352

                      4110
                      Outlays, gross (total)
                      1,772
                      14,055
                      2,305

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –343
                      –189
                      –145

                      4123
                      Non-Federal sources
                      –1,596
                      –1,852
                      –1,774

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –1,939
                      –2,041
                      –1,919

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –386

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      8

                      4150
                      Additional offsets against budget authority only (total)
                      –378

                      4160
                      Budget authority, net (mandatory)
                      81
                      11,516
                      106

                      4170
                      Outlays, net (mandatory)
                      –167
                      12,014
                      386

                      4180
                      Budget authority, net (total)
                      81
                      11,516
                      106

                      4190
                      Outlays, net (total)
                      –160
                      12,014
                      386

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      207
                      128
                      103

                      5091
                      Expiring unavailable balance: Offsetting collections
                      –1

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      128
                      103

                      5093
                      Expired unavailable balance, SOY: Offsetting collections
                      1
                      2
                      2

                      5095
                      Expired unavailable balance, EOY: Offsetting collections
                      1
                      2
                      2

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      81
                      11,516
                      106

                      Outlays
                      –160
                      12,014
                      386

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      812
                      12

                      Outlays

                      812
                      12

                      Total:

                      Budget Authority
                      81
                      12,328
                      118

                      Outlays
                      –160
                      12,826
                      398

             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. The 2019 Budget includes mandatory resources for the Risk Corridor Program.

          Object Classification (in millions of dollars)

                      Identification code 075–0511–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      466
                      483
                      450

                      11.3
                      Other than full-time permanent
                      12
                      11
                      11

                      11.5
                      Other personnel compensation
                      7
                      8
                      8

                      11.7
                      Military personnel
                      17
                      14
                      14

                      11.9
                      Total personnel compensation
                      502
                      516
                      483

                      12.1
                      Civilian personnel benefits
                      158
                      153
                      149

                      12.2
                      Military personnel benefits
                      9
                      7
                      7

                      23.1
                      Rental payments to GSA
                      11

                      23.3
                      Communications, utilities, and miscellaneous charges
                      48

                      24.0
                      Printing and reproduction
                      60

                      25.2
                      Other services from non-Federal sources
                      3,121
                      3,904
                      3,012

                      25.3
                      Other goods and services from Federal sources
                      77

                      25.6
                      Medical care
                      380

                      25.7
                      Operation and maintenance of equipment
                      1

                      41.0
                      Grants, subsidies, and contributions
                      12

                      42.0
                      Insurance claims and indemnities
                      3,953

                      99.0
                      Direct obligations
                      8,332
                      4,580
                      3,651

                      99.0
                      Reimbursable obligations
                      1,640
                      1,731
                      1,795

                      99.9
                      Total new obligations, unexpired accounts
                      9,972
                      6,311
                      5,446

          Employment Summary

                      Identification code 075–0511–0–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4,376
                      4,365
                      4,099

                      1001
                      Direct civilian full-time equivalent employment
                      159
                      157
                      157

                      1101
                      Direct military average strength employment
                      138
                      138
                      138

                      2001
                      Reimbursable civilian full-time equivalent employment
                      240
                      249
                      249

             Program Management

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

                      Identification code 075–0511–4–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Program operations

                      12

                      0100
                      Total direct program

                      12

                      0799
                      Total direct obligations

                      12

                      0801
                      ACL SHIPs

                      13
                      13

                      0804
                      Medicare advantage/Prescription drug plan

                      30

                      0899
                      Total reimbursable obligations

                      13
                      43

                      0900
                      Total new obligations, unexpired accounts

                      13
                      55

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      812

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      12

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced

                      812

                      1260
                      Appropriations, mandatory (total)

                      812
                      12

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      13
                      43

                      1900
                      Budget authority (total)

                      825
                      55

                      1930
                      Total budgetary resources available

                      825
                      867

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      812
                      812

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      –812

                      3010
                      New obligations, unexpired accounts

                      13
                      55

                      3020
                      Outlays (gross)

                      –825
                      –55

                      3050
                      Unpaid obligations, end of year

                      –812
                      –812

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      –812

                      3200
                      Obligated balance, end of year

                      –812
                      –812

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      825
                      55

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      13
                      55

                      4101
                      Outlays from mandatory balances

                      812

                      4110
                      Outlays, gross (total)

                      825
                      55

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –13
                      –13

                      4123
                      Non-Federal sources

                      –30

                      4130
                      Offsets against gross budget authority and outlays (total)

                      –13
                      –43

                      4160
                      Budget authority, net (mandatory)

                      812
                      12

                      4170
                      Outlays, net (mandatory)

                      812
                      12

                      4180
                      Budget authority, net (total)

                      812
                      12

                      4190
                      Outlays, net (total)

                      812
                      12

          Object Classification (in millions of dollars)

                      Identification code 075–0511–4–1–550
                      2017 actual
                      2018 est.
                      2019 est.

                      25.3
                      Direct obligations: Other goods and services from Federal sources

                      12

                      99.0
                      Direct obligations

                      12

                      99.0
                      Reimbursable obligations

                      13
                      43

                      99.9
                      Total new obligations, unexpired accounts

                      13
                      55

             Payments to Hospitals

             Payments to Hospitals

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

                      Identification code 075–0514–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Grants to hospitals

                      14,540

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

                      14,540

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      14,540

                      1930
                      Total budgetary resources available

                      14,540

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      14,540

                      3020
                      Outlays (gross)

                      –14,540

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      14,540

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      14,540

                      4180
                      Budget authority, net (total)

                      14,540

                      4190
                      Outlays, net (total)

                      14,540

             This account reflects the Budget's proposals to modify payments to hospitals for uncompensated care and consolidate graduate
                medical education spending.

             Children's Health Insurance Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0515–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

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

                      0002
                      CHIP Redistribution Funds
                      8
                      3,052

                      0003
                      Child health quality
                      6
                      20
                      24

                      0900
                      Total new obligations, unexpired accounts (object class 41.0)
                      15,966
                      8,772
                      5,724

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3,013
                      6,441
                      2,747

                      1011
                      Unobligated balance transfer from other acct [075–5551]
                      3,656

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      704
                      101

                      1020
                      Adjustment of unobligated bal brought forward, Oct 1

                      –170

                      1021
                      Recoveries of prior year unpaid obligations
                      8
                      2,188

                      1050
                      Unobligated balance (total)
                      7,381
                      8,560
                      2,747

                      Budget authority:

                      Appropriations, discretionary:

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

                      –2,652

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

                      –89

                      1160
                      Appropriation, discretionary (total):

                      –2,741

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      20,400
                      5,700
                      5,700

                      1221
                      Appropriations transferred from other acct [075–5551]
                      2,050

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –7,424

                      1260
                      Appropriations, mandatory (total)
                      15,026
                      5,700
                      5,700

                      1900
                      Budget authority (total)
                      15,026
                      2,959
                      5,700

                      1930
                      Total budgetary resources available
                      22,407
                      11,519
                      8,447

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      6,441
                      2,747
                      2,723

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      8,070
                      7,804
                      1,768

                      3010
                      New obligations, unexpired accounts
                      15,966
                      8,772
                      5,724

                      3020
                      Outlays (gross)
                      –16,224
                      –12,620
                      –5,724

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –8
                      –2,188

                      3050
                      Unpaid obligations, end of year
                      7,804
                      1,768
                      1,768

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      8,070
                      7,804
                      1,768

                      3200
                      Obligated balance, end of year
                      7,804
                      1,768
                      1,768

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –2,741

                      Mandatory:

                      4090
                      Budget authority, gross
                      15,026
                      5,700
                      5,700

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      8,826
                      5,700
                      5,700

                      4101
                      Outlays from mandatory balances
                      7,398
                      6,920
                      24

                      4110
                      Outlays, gross (total)
                      16,224
                      12,620
                      5,724

                      4180
                      Budget authority, net (total)
                      15,026
                      2,959
                      5,700

                      4190
                      Outlays, net (total)
                      16,224
                      12,620
                      5,724

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      15,026
                      2,959
                      5,700

                      Outlays
                      16,224
                      12,620
                      5,724

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –3,118

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      5,643
                      9,172

                      Outlays

                      4,500
                      5,700

                      Total:

                      Budget Authority
                      15,026
                      8,602
                      11,754

                      Outlays
                      16,224
                      17,120
                      11,424

             The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under title XXI of the Social Security
                Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income
                families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured children through a separate
                CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization
                Act of 2009 (P.L. 111–3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through fiscal year 2013.
                CHIPRA made some modifications to the program, including increased funding for States and territories, bonus payments for
                States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency
                fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding
                is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended funding
                for CHIP, providing appropriations through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L.
                114–10) extended CHIP funding through fiscal year 2017, and the Further Additional Continuing Appropriations Act of 2018 (P.L.
                115–96) provided partial year funding for FY 2018.

             Children's Health Insurance Fund

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

                      Identification code 075–0515–2–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

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

                      –3,118

                      1900
                      Budget authority (total)

                      –3,118

                      1930
                      Total budgetary resources available

                      –3,118

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      –3,118

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –3,118

                      4180
                      Budget authority, net (total)

                      –3,118

                      4190
                      Outlays, net (total)

             Children's Health Insurance Fund

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

                      Identification code 075–0515–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      5,643

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      4,500
                      5,700

                      1221
                      Appropriations transferred from other acct [075–5551]

                      1,143
                      3,472

                      1260
                      Appropriations, mandatory (total)

                      5,643
                      9,172

                      1930
                      Total budgetary resources available

                      5,643
                      14,815

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      5,643
                      14,815

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1

                      –4,500

                      3020
                      Outlays (gross)

                      –4,500
                      –5,700

                      3050
                      Unpaid obligations, end of year

                      –4,500
                      –10,200

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year

                      –4,500

                      3200
                      Obligated balance, end of year

                      –4,500
                      –10,200

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      5,643
                      9,172

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4,500
                      5,700

                      4180
                      Budget authority, net (total)

                      5,643
                      9,172

                      4190
                      Outlays, net (total)

                      4,500
                      5,700

             The Budget proposes to extend CHIP funding through fiscal year 2019 with reforms.

             Center for Medicare and Medicaid Innovation

             Program and Financing (in millions of dollars)

                      Identification code 075–0522–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Administration
                      302
                      395
                      342

                      0002
                      Innovation Activities
                      699
                      1,383
                      1,363

                      0900
                      Total new obligations, unexpired accounts
                      1,001
                      1,778
                      1,705

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      4,404
                      3,484
                      1,706

                      1021
                      Recoveries of prior year unpaid obligations
                      81

                      1050
                      Unobligated balance (total)
                      4,485
                      3,484
                      1,706

                      1930
                      Total budgetary resources available
                      4,485
                      3,484
                      1,706

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3,484
                      1,706
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,592
                      1,376
                      1,876

                      3010
                      New obligations, unexpired accounts
                      1,001
                      1,778
                      1,705

                      3020
                      Outlays (gross)
                      –1,136
                      –1,278
                      –1,592

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –81

                      3050
                      Unpaid obligations, end of year
                      1,376
                      1,876
                      1,989

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,592
                      1,376
                      1,876

                      3200
                      Obligated balance, end of year
                      1,376
                      1,876
                      1,989

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      1,136
                      1,278
                      1,592

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      1,136
                      1,278
                      1,592

             The Center for Medicare and Medicaid Innovation ("Innovation Center") was established by section 1115A of the Social Security
                Act (as added by section 3021 of the Patient Protection and Affordable Care Act). The Innovation Center is tasked with testing
                innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of
                care provided to individuals under Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The statute provides
                $10 billion in mandatory funding for these purposes in fiscal years 2011 through 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–0522–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      62
                      70
                      70

                      12.1
                      Civilian personnel benefits
                      19
                      22
                      22

                      23.3
                      Communications, utilities, and miscellaneous charges
                      3
                      3
                      4

                      25.2
                      Other services from non-Federal sources
                      502
                      1,220
                      1,280

                      41.0
                      Grants, subsidies, and contributions
                      375
                      391
                      224

                      42.0
                      Insurance claims and indemnities
                      40
                      72
                      105

                      99.9
                      Total new obligations, unexpired accounts
                      1,001
                      1,778
                      1,705

          Employment Summary

                      Identification code 075–0522–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      551
                      600
                      600

             Child Enrollment Contingency Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      2,048
                      570
                      1,160

                      0198
                      Adjustment for appropriation derived from the general fund of the US Treasury
                      –2,048

                      0199
                      Balance, start of year

                      570
                      1,160

                      Receipts:

                      Current law:

                      1140
                      Interest, Child Enrollment Contingency Fund
                      6
                      17
                      27

                      Proposed:

                      1240
                      Interest, Child Enrollment Contingency Fund

                      35

                      1999
                      Total receipts
                      6
                      52
                      27

                      2000
                      Total: Balances and receipts
                      6
                      622
                      1,187

                      Appropriations:

                      Current law:

                      2101
                      Child Enrollment Contingency Fund
                      –6
                      –17
                      –27

                      2103
                      Child Enrollment Contingency Fund
                      –2,048
                      –570
                      –1,160

                      2134
                      Child Enrollment Contingency Fund

                      1,160

                      2134
                      Child Enrollment Contingency Fund
                      570

                      2198
                      Adjustment for appropriation derived from the general fund of the US Treasury
                      2,048

                      2199
                      Total current law appropriations
                      564
                      573
                      –1,187

                      Proposed:

                      2201
                      Child Enrollment Contingency Fund

                      –35

                      2234
                      Child Enrollment Contingency Fund

                      667

                      2299
                      Total proposed appropriations

                      –35
                      667

                      2999
                      Total appropriations
                      564
                      538
                      –520

                      5099
                      Balance, end of year
                      570
                      1,160
                      667

          Program and Financing (in millions of dollars)

                      Identification code 075–5551–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Grants to States and US Territories
                      1

                      0900
                      Total new obligations (object class 41.0)
                      1

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3,656
                      573

                      1010
                      Unobligated balance transfer to other accts [075–0515]
                      –3,656

                      1050
                      Unobligated balance (total)

                      573

                      Budget authority:

                      Appropriations, discretionary:

                      1134
                      Appropriations precluded from obligation

                      –1,160

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,140

                      1201
                      Appropriation (special or trust fund)
                      6
                      17
                      27

                      1203
                      Appropriation (previously unavailable)
                      2,048
                      570
                      1,160

                      1220
                      Appropriations transferred to other acct [075–0515]
                      –2,050

                      1234
                      Appropriations precluded from obligation
                      –570

                      1260
                      Appropriations, mandatory (total)
                      574
                      587
                      1,187

                      1900
                      Budget authority (total)
                      574
                      –573
                      1,187

                      1930
                      Total budgetary resources available
                      574

                      1,187

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      573

                      1,187

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      224
                      198

                      3010
                      New obligations, unexpired accounts
                      1

                      3020
                      Outlays (gross)
                      –27
                      –198

                      3050
                      Unpaid obligations, end of year
                      198

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      224
                      198

                      3200
                      Obligated balance, end of year
                      198

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –1,160

                      Mandatory:

                      4090
                      Budget authority, gross
                      574
                      587
                      1,187

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      27
                      198

                      4180
                      Budget authority, net (total)
                      574
                      –573
                      1,187

                      4190
                      Outlays, net (total)
                      27
                      198

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      571
                      1,145
                      1,160

                      5001
                      Total investments, EOY: Federal securities: Par value
                      1,145
                      1,160
                      1,187

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      574
                      –573
                      1,187

                      Outlays
                      27
                      198

                      Legislative proposal, not subject to PAYGO:

                      Budget Authority

                      –667

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      2,312
                      –2,332

                      Total:

                      Budget Authority
                      574
                      1,739
                      –1,812

                      Outlays
                      27
                      198

             The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111–3) established the Child Enrollment Contingency
                Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
                it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
                number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111–148) extended the
                Contingency Fund through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114–10) extended
                the Contingency Fund through fiscal year 2017. There is no authority to make payments from the Fund in fiscal year 2018.

              The Fund receives an appropriation equal to 20 percent of the Sec. 2104(a) CHIP national allotment appropriation under the
                Social Security Act. 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.

             Child Enrollment Contingency Fund

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

                      Identification code 075–5551–2–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1134
                      Appropriations precluded from obligation

                      –667

                      1900
                      Budget authority (total)

                      –667

                      1930
                      Total budgetary resources available

                      –667

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      –667

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –667

                      4180
                      Budget authority, net (total)

                      –667

                      4190
                      Outlays, net (total)

             Child Enrollment Contingency Fund

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

                      Identification code 075–5551–4–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      2,312

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation (annual appropriation)

                      3,420
                      1,140

                      1201
                      Appropriation (special or trust fund)

                      35

                      1220
                      Appropriations transferred to other acct [075–0515]

                      –1,143
                      –3,472

                      1260
                      Appropriations, mandatory (total)

                      2,312
                      –2,332

                      1930
                      Total budgetary resources available

                      2,312
                      –20

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      2,312
                      –20

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      2,312
                      –2,332

                      4180
                      Budget authority, net (total)

                      2,312
                      –2,332

                      4190
                      Outlays, net (total)

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value

                      2,312

                      5001
                      Total investments, EOY: Federal securities: Par value

                      2,312
                      –20

             The Budget proposes to extend the Contingency Fund through fiscal year 2019.

             Medicare Health Information Technology Incentive Payments, Recovery Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0508–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Incentive payments to hospitals
                      610
                      65
                      20

                      0802
                      Incentive payments to eligible professionals
                      393

                      0900
                      Total new obligations (object class 42.0)
                      1,003
                      65
                      20

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      6
                      6

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected from the HI Trust Fund
                      649
                      65
                      20

                      1800
                      Collected from the SMI Trust Fund
                      435

                      1801
                      Change in uncollected payments, Federal sources
                      –75

                      1850
                      Spending auth from offsetting collections, mand (total)
                      1,009
                      65
                      20

                      1930
                      Total budgetary resources available
                      1,009
                      71
                      26

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      6
                      6
                      6

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      80
                      19
                      19

                      3010
                      New obligations, unexpired accounts
                      1,003
                      65
                      20

                      3020
                      Outlays (gross)
                      –1,064
                      –65
                      –20

                      3050
                      Unpaid obligations, end of year
                      19
                      19
                      19

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –246
                      –171
                      –171

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      75

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –171
                      –171
                      –171

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –166
                      –152
                      –152

                      3200
                      Obligated balance, end of year
                      –152
                      –152
                      –152

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,009
                      65
                      20

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      984
                      47
                      20

                      4101
                      Outlays from mandatory balances
                      80
                      18

                      4110
                      Outlays, gross (total)
                      1,064
                      65
                      20

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –1,084
                      –65
                      –20

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      75

                      4170
                      Outlays, net (mandatory)
                      –20

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –20

                      Memorandum (non-add) entries:

                      5090
                      Unexpired unavailable balance, SOY: Offsetting collections
                      133
                      133
                      133

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      133
                      133
                      133

             Rate Review Grants

             Program and Financing (in millions of dollars)

                      Identification code 075–0112–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Premium rate review grants
                      26
                      8

                      0900
                      Total new obligations (object class 41.0)
                      26
                      8

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      29
                      3
                      1

                      1021
                      Recoveries of prior year unpaid obligations

                      6
                      19

                      1050
                      Unobligated balance (total)
                      29
                      9
                      20

                      1930
                      Total budgetary resources available
                      29
                      9
                      20

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      3
                      1
                      20

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      71
                      69
                      45

                      3010
                      New obligations, unexpired accounts
                      26
                      8

                      3020
                      Outlays (gross)
                      –23
                      –26
                      –13

                      3040
                      Recoveries of prior year unpaid obligations, unexpired

                      –6
                      –19

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –5

                      3050
                      Unpaid obligations, end of year
                      69
                      45
                      13

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      71
                      69
                      45

                      3200
                      Obligated balance, end of year
                      69
                      45
                      13

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      23
                      26
                      13

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      23
                      26
                      13

             The Patient Protection and Affordable Care Act (P.L. 111–148) amended Section 2794 of the Public Health Service Act and provided
                that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
                program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
                2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
                insurance reform activities consistent with Section 2794 (c)(2)(B).

             Pre-Existing Condition Insurance Plan Program

             Program and Financing (in millions of dollars)

                      Identification code 075–0113–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Pre-Existing Condition Insurance Plan Program (Direct)
                      66

                      0002
                      Administration

                      103

                      0799
                      Total direct obligations
                      66
                      103

                      0900
                      Total new obligations, unexpired accounts (object class 25.2)
                      66
                      103

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      389
                      332
                      230

                      1021
                      Recoveries of prior year unpaid obligations
                      8
                      1

                      1033
                      Recoveries of prior year paid obligations
                      1

                      1050
                      Unobligated balance (total)
                      398
                      333
                      230

                      1930
                      Total budgetary resources available
                      398
                      333
                      230

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      332
                      230
                      230

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      13
                      38
                      56

                      3010
                      New obligations, unexpired accounts
                      66
                      103

                      3020
                      Outlays (gross)
                      –33
                      –84
                      –56

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –8
                      –1

                      3050
                      Unpaid obligations, end of year
                      38
                      56

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      13
                      38
                      56

                      3200
                      Obligated balance, end of year
                      38
                      56

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      33
                      84
                      56

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      1

                      4170
                      Outlays, net (mandatory)
                      32
                      84
                      56

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      32
                      84
                      56

             This account funds the Pre-Existing Condition Insurance Plan program (PCIP), which made health insurance available to people
                who had been unable to purchase insurance due to a pre-existing condition. Enrollees paid monthly premiums similar to those
                charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions.
                The funding for this program, including operating costs, was provided in the Patient Protection and Affordable Care Act (P.L.
                111–148). The PCIP program ended in fiscal year 2014, and outlays reflected in subsequent fiscal years reflect program close
                out and claims run out costs, as well as allowable administrative costs in the current year.

             Early Retiree Reinsurance Program

             Program and Financing (in millions of dollars)

                      Identification code 075–0114–0–1–551
                      2017 actual
                      2018 est.
                      2019 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
                      10
                      10
                      4

                      3020
                      Outlays (gross)

                      –6
                      –4

                      3050
                      Unpaid obligations, end of year
                      10
                      4

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      10
                      10
                      4

                      3200
                      Obligated balance, end of year
                      10
                      4

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances

                      6
                      4

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

                      6
                      4

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

             Affordable Insurance Exchange Grants

             Program and Financing (in millions of dollars)

                      Identification code 075–0115–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0002
                      Administration
                      18
                      13

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      19
                      14

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –1
                      –1

                      1260
                      Appropriations, mandatory (total)
                      18
                      13

                      1930
                      Total budgetary resources available
                      18
                      13

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      342
                      146
                      24

                      3010
                      New obligations, unexpired accounts
                      18
                      13

                      3020
                      Outlays (gross)
                      –160
                      –135
                      –24

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –54

                      3050
                      Unpaid obligations, end of year
                      146
                      24

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      342
                      146
                      24

                      3200
                      Obligated balance, end of year
                      146
                      24

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      18
                      13

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      9
                      9

                      4101
                      Outlays from mandatory balances
                      151
                      126
                      24

                      4110
                      Outlays, gross (total)
                      160
                      135
                      24

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –13

                      Additional offsets against gross budget authority only:

                      4142
                      Offsetting collections credited to expired accounts
                      13

                      4160
                      Budget authority, net (mandatory)
                      18
                      13

                      4170
                      Outlays, net (mandatory)
                      147
                      135
                      24

                      4180
                      Budget authority, net (total)
                      18
                      13

                      4190
                      Outlays, net (total)
                      147
                      135
                      24

             This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
                Exchanges. The Exchanges facilitate the purchase of qualified health plans in the individual market and allow small businesses
                to offer qualified health plans to their employees through the Small Business Health Options Program (SHOP). Section 1311
                of the Patient Protection and Affordable Care Act (P.L. 111–148) provided amounts necessary to enable the Secretary to award
                grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
                round of grants was awarded to States in December 2014.

          Object Classification (in millions of dollars)

                      Identification code 075–0115–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      3
                      3

                      25.2
                      Other services from non-Federal sources
                      15
                      10

                      99.9
                      Total new obligations, unexpired accounts
                      18
                      13

          Employment Summary

                      Identification code 075–0115–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      25
                      26

             Cost-sharing Reductions

             Program and Financing (in millions of dollars)

                      Identification code 075–0126–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Cost Sharing Reductions

                      7,197
                      7,507

                      0002
                      Basic Health Program

                      1,000
                      1,060

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

                      8,197
                      8,567

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      8,197
                      8,567

                      1930
                      Total budgetary resources available

                      8,197
                      8,567

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      8,197
                      8,567

                      3020
                      Outlays (gross)

                      –8,197
                      –8,567

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      8,197
                      8,567

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      8,197
                      8,567

                      4180
                      Budget authority, net (total)

                      8,197
                      8,567

                      4190
                      Outlays, net (total)

                      8,197
                      8,567

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority

                      8,197
                      8,567

                      Outlays

                      8,197
                      8,567

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –180
                      –471

                      Outlays

                      –180
                      –471

                      Total:

                      Budget Authority

                      8,017
                      8,096

                      Outlays

                      8,017
                      8,096

             Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers.  The FY 2019 Budget
                provides a mandatory appropriation for Cost Sharing Reduction (CSR) payments for fiscal year 2018 through the end of calendar
                year 2019.

             Cost-sharing Reductions

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

                      Identification code 075–0126–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Cost Sharing Reductions

                      –180
                      –471

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

                      –180
                      –471

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –180
                      –471

                      1930
                      Total budgetary resources available

                      –180
                      –471

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –180
                      –471

                      3020
                      Outlays (gross)

                      180
                      471

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –180
                      –471

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –180
                      –471

                      4180
                      Budget authority, net (total)

                      –180
                      –471

                      4190
                      Outlays, net (total)

                      –180
                      –471

             Risk Adjustment Program Payments

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      248
                      371
                      526

                      0198
                      Reconciliation adjustment
                      –1

                      0199
                      Balance, start of year
                      247
                      371
                      526

                      Receipts:

                      Current law:

                      1110
                      Receipts, Risk Adjustment Program
                      5,228
                      7,974
                      7,094

                      2000
                      Total: Balances and receipts
                      5,475
                      8,345
                      7,620

                      Appropriations:

                      Current law:

                      2101
                      Risk Adjustment Program Payments
                      –5,228
                      –7,974
                      –7,094

                      2103
                      Risk Adjustment Program Payments
                      –247
                      –371
                      –526

                      2132
                      Risk Adjustment Program Payments
                      371
                      526

                      2199
                      Total current law appropriations
                      –5,104
                      –7,819
                      –7,620

                      2999
                      Total appropriations
                      –5,104
                      –7,819
                      –7,620

                      5099
                      Balance, end of year
                      371
                      526

          Program and Financing (in millions of dollars)

                      Identification code 075–5733–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Risk Adjustment Program Payments (Direct)
                      3,768
                      9,154
                      7,620

                      0900
                      Total new obligations (object class 41.0)
                      3,768
                      9,154
                      7,620

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      1,336
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      5,228
                      7,974
                      7,094

                      1203
                      Appropriation (previously unavailable)
                      247
                      371
                      526

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –371
                      –526

                      1260
                      Appropriations, mandatory (total)
                      5,104
                      7,819
                      7,620

                      1930
                      Total budgetary resources available
                      5,104
                      9,155
                      7,621

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1,336
                      1
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,247
                      915
                      915

                      3010
                      New obligations, unexpired accounts
                      3,768
                      9,154
                      7,620

                      3020
                      Outlays (gross)
                      –4,100
                      –9,154
                      –7,620

                      3050
                      Unpaid obligations, end of year
                      915
                      915
                      915

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,247
                      915
                      915

                      3200
                      Obligated balance, end of year
                      915
                      915
                      915

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      5,104
                      7,819
                      7,620

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2,853
                      7,447
                      7,620

                      4101
                      Outlays from mandatory balances
                      1,247
                      1,707

                      4110
                      Outlays, gross (total)
                      4,100
                      9,154
                      7,620

                      4180
                      Budget authority, net (total)
                      5,104
                      7,819
                      7,620

                      4190
                      Outlays, net (total)
                      4,100
                      9,154
                      7,620

             Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a permanent risk adjustment program
                for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
                and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
                with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
                a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
                they are calculated.

             Transitional Reinsurance Program

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      455
                      285
                      22

                      Receipts:

                      Current law:

                      1110
                      Contributions, Transitional Reinsurance Program
                      4,546
                      376

                      2000
                      Total: Balances and receipts
                      5,001
                      661
                      22

                      Appropriations:

                      Current law:

                      2101
                      Transitional Reinsurance Program
                      –4,546
                      –375

                      2103
                      Transitional Reinsurance Program
                      –456
                      –286
                      –22

                      2132
                      Transitional Reinsurance Program
                      286
                      22

                      2199
                      Total current law appropriations
                      –4,716
                      –639
                      –22

                      2999
                      Total appropriations
                      –4,716
                      –639
                      –22

                      5099
                      Balance, end of year
                      285
                      22

          Program and Financing (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Transitional reinsurance payments
                      4,715
                      632
                      22

                      0002
                      Administrative expenses
                      1
                      7

                      0900
                      Total new obligations, unexpired accounts
                      4,716
                      639
                      22

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      4,546
                      375

                      1203
                      Appropriation (previously unavailable)
                      456
                      286
                      22

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –286
                      –22

                      1260
                      Appropriations, mandatory (total)
                      4,716
                      639
                      22

                      1930
                      Total budgetary resources available
                      4,716
                      639
                      22

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      223
                      248

                      3010
                      New obligations, unexpired accounts
                      4,716
                      639
                      22

                      3020
                      Outlays (gross)
                      –4,691
                      –887
                      –22

                      3050
                      Unpaid obligations, end of year
                      248

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      223
                      248

                      3200
                      Obligated balance, end of year
                      248

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,716
                      639
                      22

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      4,468
                      639
                      22

                      4101
                      Outlays from mandatory balances
                      223
                      248

                      4110
                      Outlays, gross (total)
                      4,691
                      887
                      22

                      4180
                      Budget authority, net (total)
                      4,716
                      639
                      22

                      4190
                      Outlays, net (total)
                      4,691
                      887
                      22

             Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111–148) established a transitional, temporary, three-year
                reinsurance program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015,
                and 2016. The Centers for Medicare & Medicaid Services assesses contributing entities a per enrollee fee to fund the reinsurance
                program, and makes payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold,
                up to a reinsurance cap. Reinsurance collections and payments are made in the year following the plan year for which they
                are applicable. Reinsurance collections and payments for the 2016 plan year, the final year of the program, were announced
                in June of 2017.

          Object Classification (in millions of dollars)

                      Identification code 075–5735–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      41.0
                      Grants, subsidies, and contributions - Transitional Reinsurance
                      4,715
                      632
                      22

                      41.0
                      Grants, subsidies, and contributions - Administration
                      1
                      7

                      99.9
                      Total new obligations, unexpired accounts
                      4,716
                      639
                      22

             Consumer Operated and Oriented Plan Program Contingency Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0524–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      16
                      124

                      0706
                      Interest on reestimates of direct loan subsidy
                      1
                      11

                      0709
                      Administrative expenses
                      1

                      0900
                      Total new obligations, unexpired accounts
                      18
                      135

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      1
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      17
                      134

                      1930
                      Total budgetary resources available
                      18
                      135

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      16
                      3
                      1

                      3010
                      New obligations, unexpired accounts
                      18
                      135

                      3020
                      Outlays (gross)
                      –30
                      –136

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1
                      –1

                      3050
                      Unpaid obligations, end of year
                      3
                      1
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      16
                      3
                      1

                      3200
                      Obligated balance, end of year
                      3
                      1
                      1

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      17
                      134

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      17
                      134

                      4101
                      Outlays from mandatory balances
                      13
                      2

                      4110
                      Outlays, gross (total)
                      30
                      136

                      4180
                      Budget authority, net (total)
                      17
                      134

                      4190
                      Outlays, net (total)
                      30
                      136

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

                      Identification code 075–0524–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct loan subsidy outlays:

                      134002
                      Solvency Loans
                      13

                      134999
                      Total subsidy outlays
                      13

                      Direct loan reestimates:

                      135001
                      Startup Loans
                      –8
                      17

                      135002
                      Solvency Loans
                      5
                      117

                      135999
                      Total direct loan reestimates
                      –3
                      134

                      Administrative expense data:

                      3580
                      Outlays from balances

                      2

             The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
                112–240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
                loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148).

          Object Classification (in millions of dollars)

                      Identification code 075–0524–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.2
                      Other services from non-Federal sources
                      1

                      41.0
                      Grants, subsidies, and contributions
                      17
                      135

                      99.9
                      Total new obligations, unexpired accounts
                      18
                      135

             Consumer Operated and Oriented Plan Program Account

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      7

                      0198
                      Reconciliation adjustment
                      –7

                      0199
                      Balance, start of year

                      2000
                      Total: Balances and receipts

                      5099
                      Balance, end of year

          Program and Financing (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0705
                      Reestimates of direct loan subsidy
                      74
                      226

                      0706
                      Interest on reestimates of direct loan subsidy
                      7
                      33

                      0709
                      Administrative expenses
                      1

                      0900
                      Total new obligations, unexpired accounts
                      82
                      259

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1

                      1

                      1021
                      Recoveries of prior year unpaid obligations

                      1

                      1050
                      Unobligated balance (total)
                      1
                      1
                      1

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      81
                      259

                      1930
                      Total budgetary resources available
                      82
                      260
                      1

                      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
                      3
                      4
                      2

                      3010
                      New obligations, unexpired accounts
                      82
                      259

                      3020
                      Outlays (gross)
                      –81
                      –260

                      3040
                      Recoveries of prior year unpaid obligations, unexpired

                      –1

                      3050
                      Unpaid obligations, end of year
                      4
                      2
                      2

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      3
                      4
                      2

                      3200
                      Obligated balance, end of year
                      4
                      2
                      2

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      81
                      259

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      81
                      259

                      4101
                      Outlays from mandatory balances

                      1

                      4110
                      Outlays, gross (total)
                      81
                      260

                      4180
                      Budget authority, net (total)
                      81
                      259

                      4190
                      Outlays, net (total)
                      81
                      260

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

                      Identification code 075–0118–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct loan reestimates:

                      135002
                      Startup Loans
                      –65
                      –8

                      135003
                      Solvency  Loans
                      38
                      252

                      135999
                      Total direct loan reestimates
                      –27
                      244

                      Administrative expense data:

                      3580
                      Outlays from balances

                      1

             Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111–148) authorized and appropriated funding for the
                Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
                insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
                markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves
                which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of
                encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section
                1322.

          Object Classification (in millions of dollars)

                      Identification code 075–0118–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.3
                      Other goods and services from Federal sources
                      1

                      41.0
                      Grants, subsidies, and contributions
                      81
                      259

                      99.9
                      Total new obligations, unexpired accounts
                      82
                      259

             Consumer Operated and Oriented Plan Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      18
                      18
                      15

                      0742
                      Downward reestimates paid to receipt accounts
                      99
                      14

                      0743
                      Interest on downward reestimates
                      8
                      1

                      0900
                      Total new obligations, unexpired accounts
                      125
                      33
                      15

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      523
                      143

                      1021
                      Recoveries of prior year unpaid obligations

                      3

                      1022
                      Capital transfer of unobligated balances to general fund
                      –1

                      1023
                      Unobligated balances applied to repay debt
                      –478
                      –143

                      1024
                      Unobligated balance of borrowing authority withdrawn

                      –3

                      1050
                      Unobligated balance (total)
                      44

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      121
                      15

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      103
                      369
                      114

                      1801
                      Change in uncollected payments, Federal sources

                      –1

                      1825
                      Spending authority from offsetting collections applied to repay debt

                      –350
                      –99

                      1850
                      Spending auth from offsetting collections, mand (total)
                      103
                      18
                      15

                      1900
                      Budget authority (total)
                      224
                      33
                      15

                      1930
                      Total budgetary resources available
                      268
                      33
                      15

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      143

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      3
                      3

                      3010
                      New obligations, unexpired accounts
                      125
                      33
                      15

                      3020
                      Outlays (gross)
                      –125
                      –33
                      –15

                      3040
                      Recoveries of prior year unpaid obligations, unexpired

                      –3

                      3050
                      Unpaid obligations, end of year
                      3

                      Uncollected payments:

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

                      3070
                      Change in uncollected pymts, Fed sources, unexpired

                      1

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      2
                      2

                      3200
                      Obligated balance, end of year
                      2

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      224
                      33
                      15

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      125
                      33
                      15

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –80
                      –259

                      4122
                      Interest on uninvested funds
                      –6
                      –2
                      –1

                      4123
                      Non-Federal sources
                      –17
                      –108
                      –113

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –103
                      –369
                      –114

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired

                      1

                      4160
                      Budget authority, net (mandatory)
                      121
                      –335
                      –99

                      4170
                      Outlays, net (mandatory)
                      22
                      –336
                      –99

                      4180
                      Budget authority, net (total)
                      121
                      –335
                      –99

                      4190
                      Outlays, net (total)
                      22
                      –336
                      –99

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      1,909
                      1,893
                      1,785

                      1251
                      Repayments: Repayments and prepayments
                      –16
                      –108
                      –112

                      1263
                      Write-offs for default: Direct loans

                      –493

                      1290
                      Outstanding, end of year
                      1,893
                      1,785
                      1,180

          Balance Sheet (in millions of dollars)

                      Identification code 075–4418–0–3–551
                      2016 actual
                      2017 actual

                      ASSETS:

                      Federal assets:

                      1101
                      Fund balances with Treasury
                      506
                      16

                      Investments in US securities:

                      1106
                      Receivables, net
                      81

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      1,909
                      1,893

                      1402
                      Interest receivable
                      12
                      20

                      1405
                      Allowance for subsidy cost (-)
                      –1,284
                      –1,278

                      1499
                      Net present value of assets related to direct loans
                      637
                      635

                      1999
                      Total assets
                      1,224
                      651

                      LIABILITIES:

                      2103
                      Federal liabilities: Debt
                      1,224
                      651

                      4999
                      Total liabilities and net position
                      1,224
                      651

             Consumer Operated and Oriented Plan Program Contingency Fund Financing Account

             Program and Financing (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      Credit program obligations:

                      0713
                      Payment of interest to Treasury
                      6
                      6
                      5

                      0742
                      Downward reestimates paid to receipt accounts
                      19

                      0743
                      Interest on downward reestimates
                      1

                      0900
                      Total new obligations, unexpired accounts
                      26
                      6
                      5

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      101
                      32
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      2
                      3

                      1023
                      Unobligated balances applied to repay debt
                      –93
                      –32

                      1024
                      Unobligated balance of borrowing authority withdrawn

                      –3

                      1050
                      Unobligated balance (total)
                      10

                      1

                      Financing authority:

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      30
                      7
                      9

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      31
                      138
                      4

                      1801
                      Change in uncollected payments, Federal sources
                      –13
                      –1

                      1825
                      Spending authority from offsetting collections applied to repay debt

                      –137
                      –4

                      1850
                      Spending auth from offsetting collections, mand (total)
                      18

                      1900
                      Budget authority (total)
                      48
                      7
                      9

                      1930
                      Total budgetary resources available
                      58
                      7
                      10

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      32
                      1
                      5

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      34
                      4
                      1

                      3010
                      New obligations, unexpired accounts
                      26
                      6
                      5

                      3020
                      Outlays (gross)
                      –54
                      –6
                      –5

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2
                      –3

                      3050
                      Unpaid obligations, end of year
                      4
                      1
                      1

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –14
                      –1

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      13
                      1

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

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      20
                      3
                      1

                      3200
                      Obligated balance, end of year
                      3
                      1
                      1

                      Financing authority and disbursements, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      48
                      7
                      9

                      Financing disbursements:

                      4110
                      Outlays, gross (total)
                      54
                      6
                      5

                      Offsets against gross financing authority and disbursements:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –29
                      –134

                      4122
                      Interest on uninvested funds
                      –2
                      –2
                      –2

                      4123
                      Non-Federal sources

                      –2
                      –2

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –31
                      –138
                      –4

                      Additional offsets against financing authority only (total):

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      13
                      1

                      4160
                      Budget authority, net (mandatory)
                      30
                      –130
                      5

                      4170
                      Outlays, net (mandatory)
                      23
                      –132
                      1

                      4180
                      Budget authority, net (total)
                      30
                      –130
                      5

                      4190
                      Outlays, net (total)
                      23
                      –132
                      1

          Status of Direct Loans (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Cumulative balance of direct loans outstanding:

                      1210
                      Outstanding, start of year
                      451
                      480
                      478

                      1231
                      Disbursements: Direct loan disbursements
                      29

                      1251
                      Repayments: Repayments and prepayments

                      –2
                      –2

                      1263
                      Write-offs for default: Direct loans

                      –138

                      1290
                      Outstanding, end of year
                      480
                      478
                      338

          Balance Sheet (in millions of dollars)

                      Identification code 075–4482–0–3–551
                      2016 actual
                      2017 actual

                      ASSETS:

                      1101
                      Federal assets: Fund balances with Treasury
                      124
                      9

                      1206
                      Non-Federal assets: Receivables, net
                      17
                      4

                      Net value of assets related to post-1991 direct loans receivable:

                      1401
                      Direct loans receivable, gross
                      451
                      480

                      1402
                      Interest receivable
                      2

                      1405
                      Allowance for subsidy cost (-)
                      –281
                      –291

                      1499
                      Net present value of assets related to direct loans
                      172
                      189

                      1999
                      Total assets
                      313
                      202

                      LIABILITIES:

                      2104
                      Federal liabilities: Resources payable to Treasury
                      293
                      202

                      2207
                      Non-Federal liabilities: Other
                      20

                      2999
                      Total liabilities
                      313
                      202

                      4999
                      Total liabilities and net position
                      313
                      202

          Trust Funds
             Federal Hospital Insurance Trust Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      158,585
                      160,218
                      164,640

                      0198
                      Unavailable unobligated balance adjustment
                      127

                      0198
                      Adjustment for change in allocation

                      –197

                      0199
                      Balance, start of year
                      158,712
                      160,021
                      164,640

                      Receipts:

                      Current law:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      237,667
                      240,175
                      255,083

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      606
                      567
                      587

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      17,657
                      18,396
                      19,544

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      446
                      641
                      683

                      1130
                      FHI Trust Fund, Other Proprietary Interest from the Public
                      1
                      2
                      2

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      389
                      398
                      429

                      1130
                      FHI Trust Fund, Medicare Refunds
                      5,841
                      6,300
                      6,350

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      1
                      3
                      3

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,492
                      3,733
                      3,948

                      1140
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,733
                      3,838
                      3,937

                      1140
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      683
                      639
                      625

                      1140
                      FHI Trust Fund, Interest Received by Trust Funds
                      7,423
                      7,168
                      6,880

                      1140
                      FHI Trust Fund, Taxation on OASDI Benefits
                      24,206
                      23,684
                      24,943

                      1140
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      131
                      135
                      147

                      1140
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      12
                      109
                      150

                      1140
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      46
                      51
                      52

                      1140
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      25
                      30
                      31

                      1140
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      31
                      26
                      28

                      1140
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      1,973
                      1,323
                      1,330

                      1199
                      Total current law receipts
                      304,363
                      307,218
                      324,752

                      Proposed:

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –2

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –50
                      2

                      1230
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible

                      –190

                      1240
                      FHI Trust Fund, Interest Received by Trust Funds

                      32
                      270

                      1240
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)

                      2

                      1299
                      Total proposed receipts

                      –18
                      82

                      1999
                      Total receipts
                      304,363
                      307,200
                      324,834

                      2000
                      Total: Balances and receipts
                      463,075
                      467,221
                      489,474

                      Appropriations:

                      Current law:

                      2101
                      Federal Hospital Insurance Trust Fund
                      –2,110
                      –1,933
                      –2,022

                      2101
                      Federal Hospital Insurance Trust Fund
                      –300,240
                      –305,249
                      –325,008

                      2101
                      Health Care Fraud and Abuse Control Account
                      –725
                      –725
                      –770

                      2101
                      Health Care Fraud and Abuse Control Account
                      –1,320
                      –1,320
                      –1,186

                      2132
                      Federal Hospital Insurance Trust Fund
                      7

                      2132
                      Health Care Fraud and Abuse Control Account
                      50
                      50

                      2134
                      Federal Hospital Insurance Trust Fund
                      1,449
                      6,614
                      2

                      2199
                      Total current law appropriations
                      –302,889
                      –302,563
                      –328,984

                      Proposed:

                      2201
                      Federal Hospital Insurance Trust Fund

                      33
                      270

                      2201
                      Federal Hospital Insurance Trust Fund

                      192

                      2203
                      Federal Hospital Insurance Trust Fund

                      –33
                      –270

                      2203
                      Federal Hospital Insurance Trust Fund

                      –18
                      13,083

                      2299
                      Total proposed appropriations

                      –18
                      13,275

                      2999
                      Total appropriations
                      –302,889
                      –302,581
                      –315,709

                      5098
                      Unavailable unobligated balance adjustment
                      32

                      5099
                      Balance, end of year
                      160,218
                      164,640
                      173,765

          Program and Financing (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI
                      297,122
                      297,842
                      323,801

                      0002
                      HIT Incentive Payments
                      648
                      65
                      20

                      0003
                      Administration, HI
                      2,580
                      2,130
                      2,227

                      0004
                      Quality improvement organizations, HI
                      552
                      522
                      980

                      0799
                      Total direct obligations
                      300,902
                      300,559
                      327,028

                      0900
                      Total new obligations, unexpired accounts
                      300,902
                      300,559
                      327,028

                      Budgetary resources:

                      Unobligated balance:

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1033
                      Recoveries of prior year paid obligations
                      6

                      1050
                      Unobligated balance (total)
                      8

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      2,110
                      1,933
                      2,022

                      1130
                      Appropriations permanently reduced

                      –9

                      1160
                      Appropriation, discretionary (total)
                      2,110
                      1,924
                      2,022

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      300,240
                      305,249
                      325,008

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                      –7

                      1234
                      Appropriations precluded from obligation
                      –1,449
                      –6,614
                      –2

                      1260
                      Appropriations, mandatory (total)
                      298,784
                      298,635
                      325,006

                      1900
                      Budget authority (total)
                      300,894
                      300,559
                      327,028

                      1930
                      Total budgetary resources available
                      300,902
                      300,559
                      327,028

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      31,859
                      35,193
                      35,141

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      197

                      3010
                      New obligations, unexpired accounts
                      300,902
                      300,559
                      327,028

                      3020
                      Outlays (gross)
                      –297,566
                      –300,808
                      –327,099

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3050
                      Unpaid obligations, end of year
                      35,193
                      35,141
                      35,070

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      31,859
                      35,390
                      35,141

                      3200
                      Obligated balance, end of year
                      35,193
                      35,141
                      35,070

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,110
                      1,924
                      2,022

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,254
                      1,230
                      1,357

                      4011
                      Outlays from discretionary balances

                      906
                      709

                      4020
                      Outlays, gross (total)
                      1,254
                      2,136
                      2,066

                      Mandatory:

                      4090
                      Budget authority, gross
                      298,784
                      298,635
                      325,006

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      269,052
                      267,101
                      293,667

                      4101
                      Outlays from mandatory balances
                      27,260
                      31,571
                      31,366

                      4110
                      Outlays, gross (total)
                      296,312
                      298,672
                      325,033

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –6

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      6

                      4160
                      Budget authority, net (mandatory)
                      298,784
                      298,635
                      325,006

                      4170
                      Outlays, net (mandatory)
                      296,306
                      298,672
                      325,033

                      4180
                      Budget authority, net (total)
                      300,894
                      300,559
                      327,028

                      4190
                      Outlays, net (total)
                      297,560
                      300,808
                      327,099

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      192,209
                      197,835
                      200,449

                      5001
                      Total investments, EOY: Federal securities: Par value
                      197,835
                      200,449
                      209,551

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      300,894
                      300,559
                      327,028

                      Outlays
                      297,560
                      300,808
                      327,099

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      18
                      –13,275

                      Outlays

                      18
                      –13,275

                      Total:

                      Budget Authority
                      300,894
                      300,577
                      313,753

                      Outlays
                      297,560
                      300,826
                      313,824

             The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
                disabled persons.

             In addition, the Budget includes a package of targeted Medicare proposals designed to eliminate wasteful Federal spending,
                reduce provider burden, and address fraud and abuse. This package strengthens the solvency of the Hospital Insurance Trust
                Fund.

          Status of Funds (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      192,518
                      197,520
                      201,343

                      0999
                      Total balance, start of year
                      192,518
                      197,520
                      201,343

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                      237,667
                      240,175
                      255,083

                      1110
                      FHI Trust Fund, Receipts from Railroad Retirement Board
                      606
                      567
                      587

                      1110
                      FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                      17,657
                      18,396
                      19,544

                      1110
                      FHI Trust Fund, Civil Penalties and Damages
                      446
                      641
                      683

                      1130
                      FHI Trust Fund, Basic Premium, Medicare Advantage
                      389
                      398
                      429

                      1130
                      FHI Trust Fund, Medicare Refunds
                      5,841
                      6,300
                      6,350

                      1130
                      Affordable Care Act Medicare Shared Savings Models (HI)
                      1
                      3
                      3

                      1130
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                      3,492
                      3,733
                      3,948

                      1130
                      Federal Hospital Insurance Trust Fund
                      6

                      1150
                      FHI Trust Fund, Interest Received by Trust Funds
                      7,423
                      7,168
                      6,880

                      1150
                      FHI Trust Fund, Other Proprietary Interest from the Public
                      1
                      2
                      2

                      1150
                      FHI Trust Fund, Interest Payments by Railroad Retirement Board
                      31
                      26
                      28

                      1160
                      FHI Trust Fund, Federal Employer Contributions (FICA)
                      3,733
                      3,838
                      3,937

                      1160
                      FHI Trust Fund, Postal Service Employer Contributions (FICA)
                      683
                      639
                      625

                      1160
                      FHI Trust Fund, Taxation on OASDI Benefits
                      24,206
                      23,684
                      24,943

                      1160
                      FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                      131
                      135
                      147

                      1160
                      FHI Trust Fund, Transfers from General Fund (criminal Fines)
                      12
                      109
                      150

                      1160
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                      46
                      51
                      52

                      1160
                      FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                      25
                      30
                      31

                      1160
                      FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                      1,973
                      1,323
                      1,330

                      1199
                      Income under present law
                      304,369
                      307,218
                      324,752

                      Proposed:

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –2

                      1210
                      FHI Trust Fund, Transfers from General Fund (FICA Taxes)

                      –50
                      2

                      Offsetting receipts (proprietary):

                      1230
                      FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible

                      –190

                      1250
                      FHI Trust Fund, Interest Received by Trust Funds

                      32
                      270

                      Offsetting governmental receipts:

                      1260
                      FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)

                      2

                      1299
                      Income proposed

                      –18
                      82

                      1999
                      Total cash income
                      304,369
                      307,200
                      324,834

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Hospital Insurance Trust Fund [009–38–8005–0]
                      –297,566
                      –300,808
                      –327,099

                      2100
                      Health Care Fraud and Abuse Control Account [009–38–8393–0]
                      –1,802
                      –2,542
                      –2,228

                      2199
                      Outgo under current law
                      –299,368
                      –303,350
                      –329,327

                      Proposed:

                      2200
                      Federal Hospital Insurance Trust Fund

                      –18
                      13,275

                      2299
                      Outgo under proposed legislation

                      –18
                      13,275

                      2999
                      Total cash outgo (-)
                      –299,368
                      –303,368
                      –316,052

                      Surplus or deficit::

                      3110
                      Excluding interest
                      –2,454
                      –3,396
                      1,602

                      3120
                      Interest
                      7,455
                      7,228
                      7,180

                      3199
                      Subtotal, surplus or deficit
                      5,001
                      3,832
                      8,782

                      3220
                      Federal Hospital Insurance Trust Fund

                      –9

                      3298
                      Rounding adjustment
                      1

                      3299
                      Total adjustments
                      1
                      –9

                      3999
                      Total change in fund balance
                      5,002
                      3,823
                      8,782

                      Unexpended balance, end of year::

                      4100
                      Uninvested balance (net), end of year
                      –315
                      894
                      574

                      4200
                      Federal Hospital Insurance Trust Fund
                      197,835
                      200,449
                      209,551

                      4999
                      Total balance, end of year
                      197,520
                      201,343
                      210,125

          Object Classification (in millions of dollars)

                      Identification code 075–8005–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      41.0
                      Payment for Quality Improvement Organization (QIO) activities
                      552
                      522
                      980

                      42.0
                      Insurance claims and indemnities (benefits)
                      297,770
                      297,907
                      323,821

                      94.0
                      Financial transfers
                      2,580
                      2,130
                      2,227

                      99.9
                      Total new obligations, unexpired accounts
                      300,902
                      300,559
                      327,028

          Employment Summary

                      Identification code 075–8005–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      3
                      3

             Federal Hospital Insurance Trust Fund

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

                      Identification code 075–8005–2–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –33
                      –270

                      1203
                      Appropriation (previously unavailable)

                      33
                      270

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Federal Hospital Insurance Trust Fund

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

                      Identification code 075–8005–4–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, HI

                      –13,293

                      0003
                      Administration, HI

                      18
                      18

                      0799
                      Total direct obligations

                      18
                      –13,275

                      0900
                      Total new obligations, unexpired accounts

                      18
                      –13,275

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –192

                      1203
                      Appropriation (previously unavailable)

                      18
                      –13,083

                      1260
                      Appropriations, mandatory (total)

                      18
                      –13,275

                      1900
                      Budget authority (total)

                      18
                      –13,275

                      1930
                      Total budgetary resources available

                      18
                      –13,275

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      18
                      –13,275

                      3020
                      Outlays (gross)

                      –18
                      13,275

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      18
                      –13,275

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      18
                      –13,275

                      4180
                      Budget authority, net (total)

                      18
                      –13,275

                      4190
                      Outlays, net (total)

                      18
                      –13,275

          Object Classification (in millions of dollars)

                      Identification code 075–8005–4–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities (benefits)

                      –13,293

                      94.0
                      Financial transfers

                      18
                      18

                      99.9
                      Total new obligations, unexpired accounts

                      18
                      –13,275

             health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management, $770,000,000, to remain available through September 30, 2020, 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 $604,389,000 shall be for the Centers for Medicare and Medicaid Services program integrity activities, of which $87,230,000 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 $78,381,000 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 2019 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 $454,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the Secretary shall support the Senior Medicare Patrol program to combat health care fraud and abuse from the funds
                provided to this account.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–8393–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Medicare integrity program
                      795
                      877
                      917

                      0002
                      FBI fraud and abuse control
                      131
                      135
                      147

                      0003
                      Other fraud and abuse control
                      279
                      286
                      313

                      0005
                      Undistributed Savings, HCFAC and SSA

                      –28
                      –191

                      0091
                      Total Mandatory
                      1,205
                      1,270
                      1,186

                      0101
                      CMS discretionary
                      614
                      569
                      604

                      0102
                      Other discretionary
                      156
                      156
                      166

                      0191
                      Total Discretionary
                      770
                      725
                      770

                      0900
                      Total new obligations, unexpired accounts
                      1,975
                      1,995
                      1,956

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      406
                      430
                      430

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      248
                      199

                      1021
                      Recoveries of prior year unpaid obligations
                      10

                      1050
                      Unobligated balance (total)
                      416
                      430
                      430

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      725
                      725
                      770

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      1,320
                      1,320
                      1,186

                      1232
                      Appropriations and/or unobligated balance of appropriations temporarily reduced
                      –50
                      –50

                      1260
                      Appropriations, mandatory (total)
                      1,270
                      1,270
                      1,186

                      1900
                      Budget authority (total)
                      1,995
                      1,995
                      1,956

                      1930
                      Total budgetary resources available
                      2,411
                      2,425
                      2,386

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –6

                      1941
                      Unexpired unobligated balance, end of year
                      430
                      430
                      430

                      Special and non-revolving trust funds:

                      1951
                      Unobligated balance expiring
                      6

                      1952
                      Expired unobligated balance, start of year
                      39
                      28
                      28

                      1953
                      Expired unobligated balance, end of year
                      22
                      28
                      28

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,617
                      1,764
                      1,217

                      3010
                      New obligations, unexpired accounts
                      1,975
                      1,995
                      1,956

                      3020
                      Outlays (gross)
                      –1,802
                      –2,542
                      –2,228

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –10

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –16

                      3050
                      Unpaid obligations, end of year
                      1,764
                      1,217
                      945

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,617
                      1,764
                      1,217

                      3200
                      Obligated balance, end of year
                      1,764
                      1,217
                      945

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      725
                      725
                      770

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      122
                      725
                      770

                      4011
                      Outlays from discretionary balances
                      485
                      83

                      4020
                      Outlays, gross (total)
                      607
                      808
                      770

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,270
                      1,270
                      1,186

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      497
                      897
                      754

                      4101
                      Outlays from mandatory balances
                      698
                      837
                      704

                      4110
                      Outlays, gross (total)
                      1,195
                      1,734
                      1,458

                      4180
                      Budget authority, net (total)
                      1,995
                      1,995
                      1,956

                      4190
                      Outlays, net (total)
                      1,802
                      2,542
                      2,228

             The Health Insurance Portability and Accountability Act of 1996 (P.L. 104–191) established the Health Care Fraud and Abuse
                Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
                HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
                (HHS), the Department of Justice, and other agencies.

             The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
                integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
                in the Analytical Perspectives volume.

          Object Classification (in millions of dollars)

                      Identification code 075–8393–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent (CMS)
                      46
                      46
                      46

                      12.1
                      Civilian personnel benefits (CMS)
                      12
                      12
                      12

                      23.3
                      Communications, utilities, and miscellaneous charges
                      12
                      12
                      12

                      25.2
                      Other services (CMS/Medicaid)
                      68
                      82
                      114

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/DOJ)
                      132
                      132
                      143

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OIG)
                      274
                      279
                      302

                      25.3
                      Other purchases of goods and services from Government accounts (HHS/OGC)
                      7
                      7
                      7

                      25.3
                      Other goods and services from Federal sources (HHS/CMS)
                      8
                      19
                      21

                      25.3
                      Other goods and services from Government accounts (HHS/FDA)
                      5
                      5
                      5

                      25.6
                      Medical care  (CMS)
                      1,280
                      1,294
                      1,338

                      92.0
                      Undistributed

                      –28
                      –191

                      94.0
                      Financial transfers (FBI)
                      131
                      135
                      147

                      99.9
                      Total new obligations, unexpired accounts
                      1,975
                      1,995
                      1,956

          Employment Summary

                      Identification code 075–8393–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      481
                      403
                      403

             Federal Supplementary Medical Insurance Trust Fund

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year
                      39,603
                      47,105
                      75,604

                      0198
                      Obligated balance (unpaid obligations) adjustment

                      –298

                      0199
                      Balance, start of year
                      39,603
                      46,807
                      75,604

                      Receipts:

                      Current law:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      4,147
                      5,997
                      2,826

                      1130
                      Other Proprietary Interest from the Public, FSMI Fund
                      7
                      3
                      3

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      4,936
                      5,240
                      5,656

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      11,072
                      11,938
                      12,558

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      457
                      492
                      553

                      1130
                      Medicare Refunds, SMI
                      5,011
                      5,242
                      5,292

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      1
                      3
                      3

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      67,357
                      78,021
                      84,296

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      12,326
                      12,461
                      12,648

                      1140
                      Federal Contributions, FSMI Fund
                      227,879
                      244,685
                      263,711

                      1140
                      Interest Received by Trust Fund, FSMI Fund
                      2,262
                      1,227
                      1,210

                      1140
                      Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI

                      3
                      4

                      1140
                      Interest, Medicare Prescription Drug Account, FSMI
                      53
                      22
                      15

                      1140
                      Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                      –131
                      422
                      642

                      1140
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      78,791
                      71,915
                      73,171

                      1140
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Total current law receipts
                      414,170
                      437,672
                      462,589

                      Proposed:

                      1230
                      Premiums Collected for Medicare Prescription Drug Account, FSMI

                      922

                      1230
                      Payments from States, Medicare Prescription Drug Account, FSMI

                      –160

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –711

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –107

                      1240
                      Federal Contributions, FSMI Fund

                      –2,484

                      1240
                      Federal Contributions for Benefits, Prescription Drug Account, SMI

                      –39
                      156

                      1299
                      Total proposed receipts

                      –39
                      –2,384

                      1999
                      Total receipts
                      414,170
                      437,633
                      460,205

                      2000
                      Total: Balances and receipts
                      453,773
                      484,440
                      535,809

                      Appropriations:

                      Current law:

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –3,314
                      –3,441
                      –3,032

                      2101
                      Federal Supplementary Medical Insurance Trust Fund
                      –315,747
                      –351,477
                      –368,115

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –402
                      –413
                      –634

                      2101
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      –94,837
                      –82,347
                      –90,808

                      2134
                      Federal Supplementary Medical Insurance Trust Fund
                      7,632
                      28,862
                      8,453

                      2199
                      Total current law appropriations
                      –406,668
                      –408,816
                      –454,136

                      Proposed:

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      2,523

                      2201
                      Federal Supplementary Medical Insurance Trust Fund

                      974

                      2201
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

                      –918

                      2203
                      Federal Supplementary Medical Insurance Trust Fund

                      –2,523

                      2203
                      Federal Supplementary Medical Insurance Trust Fund

                      –20

                      2234
                      Federal Supplementary Medical Insurance Trust Fund

                      2,308

                      2299
                      Total proposed appropriations

                      –20
                      2,364

                      2999
                      Total appropriations
                      –406,668
                      –408,836
                      –451,772

                      5099
                      Balance, end of year
                      47,105
                      75,604
                      84,037

          Program and Financing (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI
                      310,129
                      321,129
                      357,948

                      0002
                      Transfer to Medicaid for payment of SMI premiums
                      652
                      1,000
                      1,054

                      0003
                      HIT Incentive Payments
                      435

                      0004
                      Administration, SMI
                      2,825
                      3,663
                      3,213

                      0005
                      Quality Improvement Organizations, SMI
                      502
                      252
                      472

                      0799
                      Total direct obligations
                      314,543
                      326,044
                      362,687

                      0900
                      Total new obligations, unexpired accounts
                      314,543
                      326,044
                      362,687

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      6

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1033
                      Recoveries of prior year paid obligations
                      5

                      1050
                      Unobligated balance (total)
                      7

                      6

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      3,314
                      3,441
                      3,032

                      1130
                      Appropriations permanently reduced

                      –6

                      1160
                      Appropriation, discretionary (total)
                      3,314
                      3,435
                      3,032

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      315,747
                      351,477
                      368,115

                      1234
                      Appropriations precluded from obligation
                      –7,632
                      –28,862
                      –8,453

                      1236
                      Appropriations applied to repay debt
                      –613

                      1260
                      Appropriations, mandatory (total)
                      307,502
                      322,615
                      359,662

                      Borrowing authority, mandatory:

                      1400
                      Borrowing authority
                      3,720

                      1900
                      Budget authority (total)
                      314,536
                      326,050
                      362,694

                      1930
                      Total budgetary resources available
                      314,543
                      326,050
                      362,700

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      6
                      13

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      25,829
                      26,303
                      26,434

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      268

                      3010
                      New obligations, unexpired accounts
                      314,543
                      326,044
                      362,687

                      3020
                      Outlays (gross)
                      –314,067
                      –326,181
                      –362,834

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3050
                      Unpaid obligations, end of year
                      26,303
                      26,434
                      26,287

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      25,829
                      26,571
                      26,434

                      3200
                      Obligated balance, end of year
                      26,303
                      26,434
                      26,287

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,314
                      3,435
                      3,032

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,806
                      2,030
                      2,026

                      4011
                      Outlays from discretionary balances
                      2,371
                      1,455
                      1,060

                      4020
                      Outlays, gross (total)
                      4,177
                      3,485
                      3,086

                      Mandatory:

                      4090
                      Budget authority, gross
                      311,222
                      322,615
                      359,662

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      287,121
                      298,783
                      330,446

                      4101
                      Outlays from mandatory balances
                      22,769
                      23,913
                      29,302

                      4110
                      Outlays, gross (total)
                      309,890
                      322,696
                      359,748

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –5

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts
                      5

                      4160
                      Budget authority, net (mandatory)
                      311,222
                      322,615
                      359,662

                      4170
                      Outlays, net (mandatory)
                      309,885
                      322,696
                      359,748

                      4180
                      Budget authority, net (total)
                      314,536
                      326,050
                      362,694

                      4190
                      Outlays, net (total)
                      314,062
                      326,181
                      362,834

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      63,336
                      70,589
                      95,789

                      5001
                      Total investments, EOY: Federal securities: Par value
                      70,589
                      95,789
                      102,490

                      5080
                      Outstanding debt, SOY
                      –3,289
                      –6,396
                      –6,396

                      5081
                      Outstanding debt, EOY
                      –6,396
                      –6,396
                      –6,396

                      5082
                      Borrowing
                      –3,720

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      314,536
                      326,050
                      362,694

                      Outlays
                      314,062
                      326,181
                      362,834

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      20
                      –3,282

                      Outlays

                      20
                      –3,282

                      Total:

                      Budget Authority
                      314,536
                      326,070
                      359,412

                      Outlays
                      314,062
                      326,201
                      359,552

             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 targeted Medicare proposals designed to improve drug pricing and payment, address
                opioids, eliminate wasteful Federal spending and spending on government-imposed provider burdens, address fraud and abuse,
                and reform the Medicare appeals process.

          Status of Funds (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Unexpended balance, start of year:

                      0100
                      Balance, start of year
                      62,774
                      68,008
                      96,789

                      0999
                      Total balance, start of year
                      62,774
                      68,008
                      96,789

                      Cash income during the year:

                      Current law:

                      Receipts:

                      1110
                      Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                      4,147
                      5,997
                      2,826

                      1130
                      Premiums Collected for Medicare Prescription Drug Account, FSMI
                      4,936
                      5,240
                      5,656

                      1130
                      Payments from States, Medicare Prescription Drug Account, FSMI
                      11,072
                      11,938
                      12,558

                      1130
                      Basic Premium, Medicare Advantage, FSMI Trust Fund
                      457
                      492
                      553

                      1130
                      Medicare Refunds, SMI
                      5,011
                      5,242
                      5,292

                      1130
                      Affordable Care Act Medicare Shared Savings Models, SMI
                      1
                      3
                      3

                      1130
                      Premiums Collected for the Aged, FSMI Fund
                      67,357
                      78,021
                      84,296

                      1130
                      Premiums Collected for the Disabled, FSMI Fund
                      12,326
                      12,461
                      12,648

                      1130
                      Federal Supplementary Medical Insurance Trust Fund
                      5

                      1130
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                      380

                      1150
                      Interest Received by Trust Fund, FSMI Fund
                      2,262
                      1,227
                      1,210

                      1150
                      Other Proprietary Interest from the Public, FSMI Fund
                      7
                      3
                      3

                      1150
                      Interest, Medicare Prescription Drug Account, FSMI
                      53
                      22
                      15

                      1160
                      Federal Contributions, FSMI Fund
                      227,879
                      244,685
                      263,711

                      1160
                      Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI

                      3
                      4

                      1160
                      Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                      –131
                      422
                      642

                      1160
                      Federal Contributions for Benefits, Prescription Drug Account, SMI
                      78,791
                      71,915
                      73,171

                      1160
                      Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                      2
                      1
                      1

                      1199
                      Income under present law
                      414,555
                      437,672
                      462,589

                      Proposed:

                      Offsetting receipts (proprietary):

                      1230
                      Premiums Collected for Medicare Prescription Drug Account, FSMI

                      922

                      1230
                      Payments from States, Medicare Prescription Drug Account, FSMI

                      –160

                      1230
                      Premiums Collected for the Aged, FSMI Fund

                      –711

                      1230
                      Premiums Collected for the Disabled, FSMI Fund

                      –107

                      Offsetting governmental receipts:

                      1260
                      Federal Contributions, FSMI Fund

                      –2,484

                      1260
                      Federal Contributions for Benefits, Prescription Drug Account, SMI

                      –39
                      156

                      1299
                      Income proposed

                      –39
                      –2,384

                      1999
                      Total cash income
                      414,555
                      437,633
                      460,205

                      Cash outgo during year:

                      Current law:

                      2100
                      Federal Supplementary Medical Insurance Trust Fund [009–38–8004–0]
                      –314,067
                      –326,181
                      –362,834

                      2100
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009–38–8308–0]
                      –95,254
                      –82,645
                      –91,245

                      2199
                      Outgo under current law
                      –409,321
                      –408,826
                      –454,079

                      Proposed:

                      2200
                      Federal Supplementary Medical Insurance Trust Fund

                      –20
                      3,282

                      2200
                      Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

                      –918

                      2299
                      Outgo under proposed legislation

                      –20
                      2,364

                      2999
                      Total cash outgo (-)
                      –409,321
                      –408,846
                      –451,715

                      Surplus or deficit::

                      3110
                      Excluding interest
                      2,912
                      27,535
                      7,262

                      3120
                      Interest
                      2,322
                      1,252
                      1,228

                      3199
                      Subtotal, surplus or deficit
                      5,234
                      28,787
                      8,490

                      3220
                      Federal Supplementary Medical Insurance Trust Fund

                      –6

                      3299
                      Total adjustments

                      –6

                      3999
                      Total change in fund balance
                      5,234
                      28,781
                      8,490

                      Unexpended balance, end of year::

                      4100
                      Uninvested balance (net), end of year
                      –2,581
                      1,000
                      2,789

                      4200
                      Federal Supplementary Medical Insurance Trust Fund
                      70,589
                      95,789
                      102,490

                      4999
                      Total balance, end of year
                      68,008
                      96,789
                      105,279

          Object Classification (in millions of dollars)

                      Identification code 075–8004–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1
                      1

                      41.0
                      Payment for Quality Improvement Organization (QIO) activity
                      502
                      252
                      472

                      42.0
                      Insurance claims and indemnities
                      310,781
                      322,129
                      359,002

                      94.0
                      Financial transfers
                      3,260
                      3,662
                      3,212

                      99.0
                      Direct obligations
                      314,543
                      326,044
                      362,687

                      99.9
                      Total new obligations, unexpired accounts
                      314,543
                      326,044
                      362,687

          Employment Summary

                      Identification code 075–8004–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      5
                      8
                      8

             Federal Supplementary Medical Insurance Trust Fund

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

                      Identification code 075–8004–2–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –2,523

                      1203
                      Appropriation (previously unavailable)

                      2,523

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Federal Supplementary Medical Insurance Trust Fund

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

                      Identification code 075–8004–4–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Benefit payments, SMI

                      –3,302

                      0004
                      Administration, SMI

                      20
                      20

                      0799
                      Total direct obligations

                      20
                      –3,282

                      0900
                      Total new obligations, unexpired accounts

                      20
                      –3,282

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      –974

                      1203
                      Appropriation (previously unavailable)

                      20

                      1234
                      Appropriations precluded from obligation

                      –2,308

                      1260
                      Appropriations, mandatory (total)

                      20
                      –3,282

                      1900
                      Budget authority (total)

                      20
                      –3,282

                      1930
                      Total budgetary resources available

                      20
                      –3,282

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      20
                      –3,282

                      3020
                      Outlays (gross)

                      –20
                      3,282

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      20
                      –3,282

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      20
                      –3,282

                      4180
                      Budget authority, net (total)

                      20
                      –3,282

                      4190
                      Outlays, net (total)

                      20
                      –3,282

          Object Classification (in millions of dollars)

                      Identification code 075–8004–4–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      42.0
                      Insurance claims and indemnities

                      –3,302

                      94.0
                      Financial transfers

                      20
                      20

                      99.0
                      Direct obligations

                      20
                      –3,282

                      99.9
                      Total new obligations, unexpired accounts

                      20
                      –3,282

             Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Prescription Drug Benefits
                      88,263
                      82,340
                      85,996

                      0002
                      Administrative Costs
                      405
                      422
                      642

                      0799
                      Total direct obligations
                      88,668
                      82,762
                      86,638

                      0900
                      Total new obligations, unexpired accounts
                      88,668
                      82,762
                      86,638

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      2

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      402
                      413
                      634

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      94,837
                      82,347
                      90,808

                      Spending authority from offsetting collections, mandatory:

                      1801
                      Change in uncollected payments, Federal sources
                      –6,569

                      1900
                      Budget authority (total)
                      88,670
                      82,760
                      91,442

                      1930
                      Total budgetary resources available
                      88,670
                      82,762
                      91,442

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      2

                      4,804

                      Special and non-revolving trust funds:

                      1952
                      Expired unobligated balance, start of year
                      41
                      3
                      3

                      1953
                      Expired unobligated balance, end of year
                      3
                      3
                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      14,638
                      8,402
                      8,546

                      3001
                      Adjustments to unpaid obligations, brought forward, Oct 1

                      27

                      3010
                      New obligations, unexpired accounts
                      88,668
                      82,762
                      86,638

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      420

                      3020
                      Outlays (gross)
                      –95,254
                      –82,645
                      –91,245

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –70

                      3050
                      Unpaid obligations, end of year
                      8,402
                      8,546
                      3,939

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –14,110
                      –7,541
                      –7,541

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      6,569

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –7,541
                      –7,541
                      –7,541

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      528
                      888
                      1,005

                      3200
                      Obligated balance, end of year
                      861
                      1,005
                      –3,602

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      402
                      413
                      634

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      246
                      221
                      319

                      4011
                      Outlays from discretionary balances
                      2
                      72
                      113

                      4020
                      Outlays, gross (total)
                      248
                      293
                      432

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4033
                      Non-Federal sources
                      –380

                      Additional offsets against gross budget authority only:

                      4052
                      Offsetting collections credited to expired accounts
                      380

                      4070
                      Budget authority, net (discretionary)
                      402
                      413
                      634

                      4080
                      Outlays, net (discretionary)
                      –132
                      293
                      432

                      Mandatory:

                      4090
                      Budget authority, gross
                      88,268
                      82,347
                      90,808

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      80,633
                      74,212
                      81,405

                      4101
                      Outlays from mandatory balances
                      14,373
                      8,140
                      9,408

                      4110
                      Outlays, gross (total)
                      95,006
                      82,352
                      90,813

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      6,569

                      4180
                      Budget authority, net (total)
                      95,239
                      82,760
                      91,442

                      4190
                      Outlays, net (total)
                      94,874
                      82,645
                      91,245

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      95,239
                      82,760
                      91,442

                      Outlays
                      94,874
                      82,645
                      91,245

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      918

                      Outlays

                      918

                      Total:

                      Budget Authority
                      95,239
                      82,760
                      92,360

                      Outlays
                      94,874
                      82,645
                      92,163

             Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
                benefit. The Budget includes a package of proposals designed to modernize the Part D benefit by realigning incentives and
                enhancing benefit management.

          Object Classification (in millions of dollars)

                      Identification code 075–8308–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.2
                      Other services from non-Federal sources
                      405
                      422
                      642

                      42.0
                      Insurance claims and indemnities
                      88,263
                      82,340
                      85,996

                      99.0
                      Direct obligations
                      88,668
                      82,762
                      86,638

                      99.9
                      Total new obligations, unexpired accounts
                      88,668
                      82,762
                      86,638

          Employment Summary

                      Identification code 075–8308–0–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      3
                      4
                      4

             Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund

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

                      Identification code 075–8308–4–7–571
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Prescription Drug Benefits

                      918

                      0799
                      Total direct obligations

                      918

                      0900
                      Total new obligations, unexpired accounts (object class 42.0)

                      918

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)

                      918

                      1900
                      Budget authority (total)

                      918

                      1930
                      Total budgetary resources available

                      918

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      918

                      3020
                      Outlays (gross)

                      –918

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      918

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      918

                      4180
                      Budget authority, net (total)

                      918

                      4190
                      Outlays, net (total)

                      918

             Administration for Children and Families

             Federal Funds
             Temporary Assistance for Needy Families

             Program and Financing (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant
                      16,432
                      16,433
                      16,433

                      0002
                      Territories - family assistance grants
                      78
                      78
                      78

                      0006
                      Tribal work programs
                      8
                      8
                      8

                      0009
                      Healthy marriage and responsible fatherhood grants
                      144
                      148
                      150

                      0010
                      Evaluation Funding and What Works Clearinghouse
                      44
                      45
                      45

                      0011
                      Census Bureau Research
                      10
                      10
                      10

                      0900
                      Total new obligations, unexpired accounts
                      16,716
                      16,722
                      16,724

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      16,739
                      16,739
                      16,739

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

                      1260
                      Appropriations, mandatory (total)
                      16,737
                      16,737
                      16,739

                      1930
                      Total budgetary resources available
                      16,737
                      16,737
                      16,739

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –21
                      –15
                      –15

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,037
                      7,772
                      8,163

                      3010
                      New obligations, unexpired accounts
                      16,716
                      16,722
                      16,724

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

                      3020
                      Outlays (gross)
                      –15,974
                      –16,331
                      –16,511

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –12

                      3050
                      Unpaid obligations, end of year
                      7,772
                      8,163
                      8,376

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,037
                      7,772
                      8,163

                      3200
                      Obligated balance, end of year
                      7,772
                      8,163
                      8,376

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      16,737
                      16,737
                      16,739

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      11,468
                      12,072
                      12,073

                      4101
                      Outlays from mandatory balances
                      4,506
                      4,259
                      4,438

                      4110
                      Outlays, gross (total)
                      15,974
                      16,331
                      16,511

                      4180
                      Budget authority, net (total)
                      16,737
                      16,737
                      16,739

                      4190
                      Outlays, net (total)
                      15,974
                      16,331
                      16,511

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      16,737
                      16,737
                      16,739

                      Outlays
                      15,974
                      16,331
                      16,511

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,602

                      Outlays

                      –1,155

                      Total:

                      Budget Authority
                      16,737
                      16,737
                      15,137

                      Outlays
                      15,974
                      16,331
                      15,356

             This account provides funding for the Temporary Assistance for Needy Families (TANF) block grant and related activities authorized
                by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction
                Act of 2005 (P.L. 109–171). The Consolidated Appropriations Act, 2017 (P.L. 115–31) authorized TANF for fiscal years 2017
                and 2018. The Budget proposes to create a comprehensive demonstration opportunity for states to grow capacity across public
                safety net benefit programs to reduce dependency; continue and modify TANF to refocus the program on the core principle of
                promoting employment; continue the 0.33 percent set-aside for TANF evaluation, research, and technical assistance; and to
                reduce the authorized funding for TANF Family Assistance Grants to States, territories, and tribes by 10 percent.

          Object Classification (in millions of dollars)

                      Identification code 075–1552–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      6
                      7
                      7

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.5
                      Other personnel compensation
                      1

                      11.9
                      Total personnel compensation
                      8
                      8
                      8

                      12.1
                      Civilian personnel benefits
                      2
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      71
                      68
                      67

                      25.3
                      Other goods and services from Federal sources
                      2
                      7
                      7

                      25.4
                      Operation and maintenance of facilities
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      16,629
                      16,634
                      16,637

                      99.9
                      Total new obligations, unexpired accounts
                      16,716
                      16,722
                      16,724

          Employment Summary

                      Identification code 075–1552–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      105
                      106
                      106

             Temporary Assistance for Needy Families

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

                      Identification code 075–1552–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      State family assistance grant

                      –1,594

                      0002
                      Territories - family assistance grants

                      –8

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

                      –1,602

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,602

                      1930
                      Total budgetary resources available

                      –1,602

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,602

                      3020
                      Outlays (gross)

                      1,155

                      3050
                      Unpaid obligations, end of year

                      –447

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –447

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,602

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,155

                      4180
                      Budget authority, net (total)

                      –1,602

                      4190
                      Outlays, net (total)

                      –1,155

             Contingency Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–1522–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Contingency Fund for State Welfare Programs
                      608
                      608
                      608

                      0900
                      Total new obligations (object class 41.0)
                      608
                      608
                      608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      608
                      608
                      608

                      1900
                      Budget authority (total)
                      608
                      608
                      608

                      1930
                      Total budgetary resources available
                      608
                      608
                      608

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      72
                      113
                      95

                      3010
                      New obligations, unexpired accounts
                      608
                      608
                      608

                      3020
                      Outlays (gross)
                      –567
                      –626
                      –609

                      3050
                      Unpaid obligations, end of year
                      113
                      95
                      94

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      72
                      113
                      95

                      3200
                      Obligated balance, end of year
                      113
                      95
                      94

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      608
                      608
                      608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      529
                      545
                      545

                      4101
                      Outlays from mandatory balances
                      38
                      81
                      64

                      4110
                      Outlays, gross (total)
                      567
                      626
                      609

                      4180
                      Budget authority, net (total)
                      608
                      608
                      608

                      4190
                      Outlays, net (total)
                      567
                      626
                      609

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      608
                      608
                      608

                      Outlays
                      567
                      626
                      609

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –608

                      Outlays

                      –545

                      Total:

                      Budget Authority
                      608
                      608

                      Outlays
                      567
                      626
                      64

             The Budget proposes to eliminate funding for the Contingency Fund.

             Contingency Fund

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

                      Identification code 075–1522–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Contingency fund

                      –608

                      0900
                      Total new obligations (object class 41.0)

                      –608

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –608

                      1930
                      Total budgetary resources available

                      –608

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –608

                      3020
                      Outlays (gross)

                      545

                      3050
                      Unpaid obligations, end of year

                      –63

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –63

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –608

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –545

                      4180
                      Budget authority, net (total)

                      –608

                      4190
                      Outlays, net (total)

                      –545

             Payments to states for child support enforcement and family support programsFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
                of July 5, 1960 (24 U.S.C. 321–329), $2,922,247,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2020, $1,400,000,000, to remain available until expended.
          For carrying out, after May 31 of the current fiscal year, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI
                of the Social Security Act and the Act of July 5, 1960 (24 U.S.C. 321–329), for the last 3 months of the current fiscal year
                for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1501–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs
                      3,826
                      3,901
                      3,890

                      0002
                      Child support incentive payments
                      572
                      581
                      589

                      0003
                      Access and visitation grants
                      10
                      10
                      10

                      0091
                      Subtotal, child support enforcement
                      4,408
                      4,492
                      4,489

                      0102
                      Payments to territories
                      33
                      33
                      33

                      0103
                      Repatriation
                      3
                      1
                      1

                      0191
                      Subtotal, other payments
                      36
                      34
                      34

                      0799
                      Total direct obligations
                      4,444
                      4,526
                      4,523

                      0801
                      Offset obligations (CSE grants to States)
                      10
                      13
                      13

                      0900
                      Total new obligations, unexpired accounts
                      4,454
                      4,539
                      4,536

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      35
                      22

                      1021
                      Recoveries of prior year unpaid obligations
                      187
                      200
                      200

                      1029
                      Other balances withdrawn to Treasury
                      –32

                      1050
                      Unobligated balance (total)
                      155
                      235
                      222

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      3,011
                      2,926
                      2,922

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      1,300
                      1,400
                      1,400

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      23

                      13

                      1900
                      Budget authority (total)
                      4,334
                      4,326
                      4,335

                      1930
                      Total budgetary resources available
                      4,489
                      4,561
                      4,557

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      35
                      22
                      21

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,093
                      1,262
                      1,395

                      3010
                      New obligations, unexpired accounts
                      4,454
                      4,539
                      4,536

                      3020
                      Outlays (gross)
                      –4,098
                      –4,206
                      –4,271

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –187
                      –200
                      –200

                      3050
                      Unpaid obligations, end of year
                      1,262
                      1,395
                      1,460

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,093
                      1,262
                      1,395

                      3200
                      Obligated balance, end of year
                      1,262
                      1,395
                      1,460

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      4,334
                      4,326
                      4,335

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      3,663
                      3,676
                      3,686

                      4101
                      Outlays from mandatory balances
                      435
                      530
                      585

                      4110
                      Outlays, gross (total)
                      4,098
                      4,206
                      4,271

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –23

                      –13

                      4180
                      Budget authority, net (total)
                      4,311
                      4,326
                      4,322

                      4190
                      Outlays, net (total)
                      4,075
                      4,206
                      4,258

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      4,311
                      4,326
                      4,322

                      Outlays
                      4,075
                      4,206
                      4,258

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      76

                      Outlays

                      76

                      Total:

                      Budget Authority
                      4,311
                      4,326
                      4,398

                      Outlays
                      4,075
                      4,206
                      4,334

             This account provides for payments to States for child support enforcement and other family support programs, including access
                and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
                account. The Budget improves establishment and enforcement procedures by closing loopholes and improving Federal processes.
                Proposals target systems modernization, increased collections, expanded distribution, and improved program efficiency.

          Object Classification (in millions of dollars)

                      Identification code 075–1501–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      41.0
                      Direct obligations: Grants, subsidies, and contributions
                      4,444
                      4,526
                      4,523

                      99.0
                      Reimbursable obligations
                      10
                      13
                      13

                      99.9
                      Total new obligations, unexpired accounts
                      4,454
                      4,539
                      4,536

             Payments to States for Child Support Enforcement and Family Support Programs

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

                      Identification code 075–1501–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      State child support administrative costs

                      76

                      0091
                      Subtotal, child support enforcement

                      76

                      0799
                      Total direct obligations

                      76

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      76

                      1900
                      Budget authority (total)

                      76

                      1930
                      Total budgetary resources available

                      76

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      76

                      3020
                      Outlays (gross)

                      –76

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      76

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      76

                      4180
                      Budget authority, net (total)

                      76

                      4190
                      Outlays, net (total)

                      76

          Object Classification (in millions of dollars)

                      Identification code 075–1501–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services

                      120

                      41.0
                      Grants, subsidies, and contributions

                      –44

                      99.0
                      Direct obligations

                      76

                      99.9
                      Total new obligations, unexpired accounts

                      76

             Low income home energy assistance
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      LIHEAP Block Grant
                      3,394
                      3,367

                      Budgetary resources:

                      Unobligated balance:

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      3

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      4

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      3,390
                      3,367

                      1930
                      Total budgetary resources available
                      3,394
                      3,367

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,229
                      1,421
                      1,517

                      3010
                      New obligations, unexpired accounts
                      3,394
                      3,367

                      3020
                      Outlays (gross)
                      –3,183
                      –3,271
                      –1,079

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –18

                      3050
                      Unpaid obligations, end of year
                      1,421
                      1,517
                      438

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,229
                      1,421
                      1,517

                      3200
                      Obligated balance, end of year
                      1,421
                      1,517
                      438

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      3,390
                      3,367

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,170
                      2,155

                      4011
                      Outlays from discretionary balances
                      1,013
                      1,116
                      1,079

                      4020
                      Outlays, gross (total)
                      3,183
                      3,271
                      1,079

                      4180
                      Budget authority, net (total)
                      3,390
                      3,367

                      4190
                      Outlays, net (total)
                      3,183
                      3,271
                      1,079

          Object Classification (in millions of dollars)

                      Identification code 075–1502–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      3
                      3

                      41.0
                      Grants, subsidies, and contributions
                      3,391
                      3,364

                      99.9
                      Total new obligations, unexpired accounts
                      3,394
                      3,367

             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"), and the Torture Victims Relief Act of 1998, $1,242,311,000, of which $1,212,821,000 shall remain available through September 30, 2021 for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out 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.
          In addition, $200,000,000 shall be available to carry out such sections 235 and 462: (1) if, at any point during this fiscal
                   year the Secretary has transferred from other accounts to this account an amount equal to at least 3 percent of the amount
                   appropriated to this account in the first paragraph, and has determined that such transfers are needed to support caseloads
                   that are higher than average; (2) if the Secretary has determined that, in each of two consecutive months during this fiscal
                   year, the number of unaccompanied alien children transferred to the custody of the Secretary pursuant to such section 235
                   has increased from the number so transferred in the previous month, and that, in the second of such months, the number so
                   transferred is at least 120 percent of the number so transferred in the first of such months; and (3) if the Secretary has
                   determined that, for each of two non-overlapping seven-day periods during the two-month period, the average number of unaccompanied
                   alien children in the custody of the Office of Refugee Resettlement who are discharged in a day is less than 1.2 percent of
                   the average number of such children who are in such custody in a day.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Refugee and entrant assistance
                      705
                      692
                      514

                      0002
                      Assistance for treatment of torture victims
                      11
                      11
                      11

                      0003
                      Unaccompanied Children
                      1,395
                      942
                      798

                      0005
                      Trafficking Victims program
                      11
                      19
                      19

                      0900
                      Total new obligations, unexpired accounts
                      2,122
                      1,664
                      1,342

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      98
                      190
                      190

                      1011
                      Unobligated balance transfer from other acct [075–0125]
                      300

                      1011
                      Unobligated balance transfer from other acct [075–1536]
                      6

                      1011
                      Unobligated balance transfer from other acct [075–0350]
                      2

                      1021
                      Recoveries of prior year unpaid obligations
                      72

                      1050
                      Unobligated balance (total)
                      478
                      190
                      190

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Base Appropriation
                      1,676
                      1,664
                      1,242

                      1100
                      UAC Contingency Fund

                      100

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

                      1121
                      Appropriations transferred from other acct [075–1536]
                      39

                      1121
                      Appropriations transferred from other acct [075–1700]
                      1

                      1121
                      Appropriations transferred from other acct [075–0142]
                      4

                      1121
                      Appropriations transferred from other acct [075–1362]
                      8

                      1121
                      Appropriations transferred from other acct [075–0943]
                      14

                      1121
                      Appropriations transferred from other acct [075–0350]
                      14

                      1121
                      Appropriations transferred from other acct [075–9915]
                      72

                      1121
                      Appropriations transferred from other acct [075–0140]
                      4

                      1160
                      Appropriation, discretionary (total)
                      1,833
                      1,664
                      1,342

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      8

                      1900
                      Budget authority (total)
                      1,841
                      1,664
                      1,342

                      1930
                      Total budgetary resources available
                      2,319
                      1,854
                      1,532

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –7

                      1941
                      Unexpired unobligated balance, end of year
                      190
                      190
                      190

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      996
                      1,003
                      888

                      3010
                      New obligations, unexpired accounts
                      2,122
                      1,664
                      1,342

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

                      3020
                      Outlays (gross)
                      –2,007
                      –1,779
                      –1,442

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –72

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –37

                      3050
                      Unpaid obligations, end of year
                      1,003
                      888
                      788

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      996
                      1,003
                      888

                      3200
                      Obligated balance, end of year
                      1,003
                      888
                      788

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,841
                      1,664
                      1,342

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,260
                      1,082
                      872

                      4011
                      Outlays from discretionary balances
                      747
                      697
                      570

                      4020
                      Outlays, gross (total)
                      2,007
                      1,779
                      1,442

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –8

                      4180
                      Budget authority, net (total)
                      1,833
                      1,664
                      1,342

                      4190
                      Outlays, net (total)
                      1,999
                      1,779
                      1,442

             This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
                programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
                for refugee benefits. The account also includes funding for the rehabilitation of victims of torture and human trafficking
                and for the care and placement of unaccompanied alien children.

          Object Classification (in millions of dollars)

                      Identification code 075–1503–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      11
                      9
                      10

                      11.7
                      Military personnel

                      1
                      1

                      11.9
                      Total personnel compensation
                      11
                      10
                      11

                      12.1
                      Civilian personnel benefits
                      4
                      3
                      3

                      23.1
                      Rental payments to GSA
                      4
                      4
                      4

                      25.1
                      Advisory and assistance services
                      227
                      229
                      80

                      25.2
                      Other services from non-Federal sources
                      4
                      2
                      2

                      25.3
                      Other goods and services from Federal sources
                      37
                      23
                      23

                      41.0
                      Grants, subsidies, and contributions
                      1,835
                      1,393
                      1,219

                      99.9
                      Total new obligations, unexpired accounts
                      2,122
                      1,664
                      1,342

          Employment Summary

                      Identification code 075–1503–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      86
                      89
                      89

                      1101
                      Direct military average strength employment
                      7
                      11
                      11

             Promoting Safe and Stable FamiliesFor carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out, except as otherwise provided, section 437 of such Act, $59,765,000.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Grants to States and Tribes
                      343
                      343
                      364

                      0002
                      Research, training and technical assistance
                      8
                      7
                      8

                      0003
                      State court improvement activities
                      30
                      11
                      32

                      0004
                      Family Connection Grants
                      2
                      1
                      1

                      0005
                      Personal Responsibility Education (PREP)
                      70
                      17
                      9

                      0006
                      Abstinence Education
                      63

                      0900
                      Total new obligations, unexpired accounts
                      516
                      379
                      414

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      25
                      28
                      10

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      3

                      1050
                      Unobligated balance (total)
                      29
                      28
                      10

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      60
                      59
                      60

                      1130
                      Appropriations permanently reduced

                      –20

                      1160
                      Appropriation, discretionary (total)
                      60
                      39
                      60

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      495
                      345
                      345

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –34
                      –23

                      1260
                      Appropriations, mandatory (total)
                      461
                      322
                      345

                      1900
                      Budget authority (total)
                      521
                      361
                      405

                      1930
                      Total budgetary resources available
                      550
                      389
                      415

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –6

                      1941
                      Unexpired unobligated balance, end of year
                      28
                      10
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      563
                      595
                      478

                      3010
                      New obligations, unexpired accounts
                      516
                      379
                      414

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

                      3020
                      Outlays (gross)
                      –465
                      –496
                      –434

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –3

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –18

                      3050
                      Unpaid obligations, end of year
                      595
                      478
                      458

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      563
                      595
                      478

                      3200
                      Obligated balance, end of year
                      595
                      478
                      458

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      60
                      39
                      60

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      18
                      12
                      21

                      4011
                      Outlays from discretionary balances
                      36
                      39
                      28

                      4020
                      Outlays, gross (total)
                      54
                      51
                      49

                      Mandatory:

                      4090
                      Budget authority, gross
                      461
                      322
                      345

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      90
                      95
                      109

                      4101
                      Outlays from mandatory balances
                      321
                      350
                      276

                      4110
                      Outlays, gross (total)
                      411
                      445
                      385

                      4180
                      Budget authority, net (total)
                      521
                      361
                      405

                      4190
                      Outlays, net (total)
                      465
                      496
                      434

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      521
                      361
                      405

                      Outlays
                      465
                      496
                      434

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      190

                      Outlays

                      17

                      Total:

                      Budget Authority
                      521
                      361
                      595

                      Outlays
                      465
                      496
                      451

             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 proposal to expand the Regional Partnership Grants program, a five-year
                reauthorization of Promoting Safe and Stable Families, and a one-year reauthorization, with modifications, of Abstinence Education
                and the Personal Responsibility Education Program (PREP).

          Object Classification (in millions of dollars)

                      Identification code 075–1512–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      12
                      7
                      7

                      25.3
                      Other goods and services from Federal sources
                      2
                      2
                      2

                      41.0
                      Grants, subsidies, and contributions
                      501
                      369
                      404

                      99.9
                      Total new obligations, unexpired accounts
                      516
                      379
                      414

          Employment Summary

                      Identification code 075–1512–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      11
                      10
                      10

             Promoting Safe and Stable Families

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

                      Identification code 075–1512–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Grants to States and Tribes

                      40

                      0005
                      PREP

                      75

                      0006
                      Abstinence Education

                      75

                      0900
                      Total new obligations, unexpired accounts

                      190

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      190

                      1930
                      Total budgetary resources available

                      190

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      190

                      3020
                      Outlays (gross)

                      –17

                      3050
                      Unpaid obligations, end of year

                      173

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      173

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      190

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      17

                      4180
                      Budget authority, net (total)

                      190

                      4190
                      Outlays, net (total)

                      17

          Object Classification (in millions of dollars)

                      Identification code 075–1512–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      23.1
                      Rental payments to GSA

                      1

                      25.1
                      Advisory and assistance services

                      10

                      25.3
                      Other goods and services from Federal sources

                      1

                      41.0
                      Grants, subsidies, and contributions

                      178

                      99.9
                      Total new obligations, unexpired accounts

                      190

          Employment Summary

                      Identification code 075–1512–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      3

             Child Care Entitlement to States

             Program and Financing (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Mandatory child care
                      1,178
                      1,178
                      1,178

                      0002
                      Matching child care
                      1,689
                      1,662
                      1,651

                      0003
                      Child Care Training and technical assistance
                      14
                      15
                      15

                      0004
                      Child care tribal grants
                      58
                      58
                      58

                      0005
                      Child Care Research
                      4
                      4
                      15

                      0900
                      Total new obligations, unexpired accounts
                      2,943
                      2,917
                      2,917

                      Budgetary resources:

                      Unobligated balance:

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      27

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      2,917
                      2,917
                      2,917

                      1930
                      Total budgetary resources available
                      2,944
                      2,917
                      2,917

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,053
                      1,060
                      967

                      3010
                      New obligations, unexpired accounts
                      2,943
                      2,917
                      2,917

                      3020
                      Outlays (gross)
                      –2,905
                      –3,010
                      –2,943

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –31

                      3050
                      Unpaid obligations, end of year
                      1,060
                      967
                      941

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,053
                      1,060
                      967

                      3200
                      Obligated balance, end of year
                      1,060
                      967
                      941

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      2,917
                      2,917
                      2,917

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2,137
                      2,174
                      2,167

                      4101
                      Outlays from mandatory balances
                      768
                      836
                      776

                      4110
                      Outlays, gross (total)
                      2,905
                      3,010
                      2,943

                      4180
                      Budget authority, net (total)
                      2,917
                      2,917
                      2,917

                      4190
                      Outlays, net (total)
                      2,905
                      3,010
                      2,943

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      2,917
                      2,917
                      2,917

                      Outlays
                      2,905
                      3,010
                      2,943

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      671

                      Outlays

                      499

                      Total:

                      Budget Authority
                      2,917
                      2,917
                      3,588

                      Outlays
                      2,905
                      3,010
                      3,442

             This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Consolidated Appropriations
                Act, 2017 (P.L. 115–31). The Budget increases funding for this account to ensure federal funding for key child care programs
                is maintained, given the effects of other Budget proposals on child care spending.

          Object Classification (in millions of dollars)

                      Identification code 075–1550–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      7
                      7
                      18

                      25.3
                      Other goods and services from Federal sources
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      2,935
                      2,909
                      2,898

                      99.9
                      Total new obligations, unexpired accounts
                      2,943
                      2,917
                      2,917

             Child Care Entitlement to States

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

                      Identification code 075–1550–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0002
                      Matching child care

                      651

                      0003
                      Child Care Training and technical assistance

                      3

                      0004
                      Child care tribal grants

                      14

                      0005
                      Child Care Research

                      3

                      0900
                      Total new obligations, unexpired accounts

                      671

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      671

                      1930
                      Total budgetary resources available

                      671

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      671

                      3020
                      Outlays (gross)

                      –499

                      3050
                      Unpaid obligations, end of year

                      172

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      172

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      671

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      499

                      4180
                      Budget authority, net (total)

                      671

                      4190
                      Outlays, net (total)

                      499

          Object Classification (in millions of dollars)

                      Identification code 075–1550–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services

                      7

                      41.0
                      Grants, subsidies, and contributions

                      664

                      99.9
                      Total new obligations, unexpired accounts

                      671

             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"), $2,560,000,000 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: Provided further, That none of the funds provided under this heading may be used to implement the national toll-free hotline
                   under section 658L(b) of the CCDBG Act.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Child Care Block grant payments to States
                      2,845
                      2,827
                      2,547

                      0004
                      Child Care Research and evaluation fund
                      10
                      10
                      13

                      0900
                      Total new obligations, unexpired accounts
                      2,855
                      2,837
                      2,560

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      2,856
                      2,837
                      2,560

                      1930
                      Total budgetary resources available
                      2,856
                      2,837
                      2,560

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,071
                      1,122
                      1,109

                      3010
                      New obligations, unexpired accounts
                      2,855
                      2,837
                      2,560

                      3020
                      Outlays (gross)
                      –2,801
                      –2,850
                      –2,644

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –3

                      3050
                      Unpaid obligations, end of year
                      1,122
                      1,109
                      1,025

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,071
                      1,122
                      1,109

                      3200
                      Obligated balance, end of year
                      1,122
                      1,109
                      1,025

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      2,856
                      2,837
                      2,560

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      2,036
                      1,997
                      1,800

                      4011
                      Outlays from discretionary balances
                      765
                      853
                      844

                      4020
                      Outlays, gross (total)
                      2,801
                      2,850
                      2,644

                      4180
                      Budget authority, net (total)
                      2,856
                      2,837
                      2,560

                      4190
                      Outlays, net (total)
                      2,801
                      2,850
                      2,644

             This program provides grants to States for child care subsidies for low-income working families and activities to improve
                child care quality.

          Object Classification (in millions of dollars)

                      Identification code 075–1515–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.1
                      Advisory and assistance services
                      22
                      21
                      23

                      25.3
                      Other goods and services from Federal sources

                      2
                      2

                      41.0
                      Grants, subsidies, and contributions
                      2,833
                      2,814
                      2,535

                      99.9
                      Total new obligations, unexpired accounts
                      2,855
                      2,837
                      2,560

             Social services block grant
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Social Services Block Grant
                      1,583
                      1,588
                      1,700

                      0002
                      Health Profession Opportunity Grants
                      79

                      0900
                      Total new obligations, unexpired accounts
                      1,662
                      1,588
                      1,700

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      32
                      31
                      22

                      1031
                      Other balances not available

                      –9

                      1050
                      Unobligated balance (total)
                      32
                      22
                      22

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,785
                      1,700
                      1,700

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –123
                      –112

                      1260
                      Appropriations, mandatory (total)
                      1,662
                      1,588
                      1,700

                      1930
                      Total budgetary resources available
                      1,694
                      1,610
                      1,722

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      31
                      22
                      22

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      480
                      468
                      435

                      3010
                      New obligations, unexpired accounts
                      1,662
                      1,588
                      1,700

                      3020
                      Outlays (gross)
                      –1,661
                      –1,621
                      –1,718

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –13

                      3050
                      Unpaid obligations, end of year
                      468
                      435
                      417

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      480
                      468
                      435

                      3200
                      Obligated balance, end of year
                      468
                      435
                      417

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      1,662
                      1,588
                      1,700

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1,313
                      1,318
                      1,411

                      4101
                      Outlays from mandatory balances
                      348
                      303
                      307

                      4110
                      Outlays, gross (total)
                      1,661
                      1,621
                      1,718

                      4180
                      Budget authority, net (total)
                      1,662
                      1,588
                      1,700

                      4190
                      Outlays, net (total)
                      1,661
                      1,621
                      1,718

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      1,662
                      1,588
                      1,700

                      Outlays
                      1,661
                      1,621
                      1,718

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      –1,615

                      Outlays

                      –1,408

                      Total:

                      Budget Authority
                      1,662
                      1,588
                      85

                      Outlays
                      1,661
                      1,621
                      310

             The Budget proposes to reduce the authorized funding level for the Social Services Block Grant to $0. The account also provides
                funding for the Health Profession Opportunity Grants demonstration to provide education and training to Temporary Assistance
                for Needy Families recipients and other low income individuals for health care occupations in high demand. The Budget proposes
                extending the demonstration through FY 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–1534–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      1

                      25.1
                      Advisory and assistance services
                      13

                      41.0
                      Grants, subsidies, and contributions
                      1,648
                      1,588
                      1,700

                      99.9
                      Total new obligations, unexpired accounts
                      1,662
                      1,588
                      1,700

          Employment Summary

                      Identification code 075–1534–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      8

             Social Services Block Grant

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

                      Identification code 075–1534–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0002
                      Health Profession Opportunity Grants

                      85

                      0003
                      Social Services Block Grant

                      –1,700

                      0900
                      Total new obligations, unexpired accounts

                      –1,615

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      –1,615

                      1900
                      Budget authority (total)

                      –1,615

                      1930
                      Total budgetary resources available

                      –1,615

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      –1,615

                      3020
                      Outlays (gross)

                      1,408

                      3050
                      Unpaid obligations, end of year

                      –207

                      Memorandum (non-add) entries:

                      3200
                      Obligated balance, end of year

                      –207

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      –1,615

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      –1,408

                      4180
                      Budget authority, net (total)

                      –1,615

                      4190
                      Outlays, net (total)

                      –1,408

          Object Classification (in millions of dollars)

                      Identification code 075–1534–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1

                      25.1
                      Advisory and assistance services

                      11

                      41.0
                      Grants, subsidies, and contributions

                      –1,627

                      99.9
                      Total new obligations, unexpired accounts

                      –1,615

          Employment Summary

                      Identification code 075–1534–4–1–506
                      2017 actual
                      2018 est.
                      2019 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; $10,323,890,000, of which $37,943,000, to remain available through September 30, 2020, 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, 2019: Provided, That $9,275,000,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $21,905,000 shall be available for a cost of living adjustment notwithstanding section 640(a)(3)(A) of such Act: Provided
                   further, That with respect to any subsequent continuing appropriations act, the previous proviso shall not be construed as
                   an authority or condition under this Act and shall not apply in fiscal year 2020 to amounts provided by such a continuing
                   appropriations act, notwithstanding any other law: Provided further, That of the amount identified in the first proviso, $14,000,000
                   shall be available to supplement funding otherwise available for research, evaluation, and federal administrative costs: Provided further, That of the amount identified in the first proviso, $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 the Head Start 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 funds described in the preceding proviso 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 notwithstanding any proviso under this heading in a prior Act making appropriations for a prior fiscal
                   year (other than amounts that were designated by the Congress as an emergency requirement pursuant to a concurrent resolution
                   on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985), any amount issued through a grant for the
                   purposes described in the following proviso shall be included in any calculation of "base grant", as such term is used in
                   section 640(a)(7)(A) of such Act, that affects the allocation of funds appropriated in this Act: Provided further, That the
                   previous proviso applies to funds granted for Early Head Start programs as described in section 645A of the Head Start Act,
                   for conversion of Head Start services to Early Head Start services as described in section 645(a)(5)(A) of such Act, and for
                   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: Provided further, That the Secretary may reduce the reservation of
                   funds under section 640(a)(2)(C) of such Act in lieu of reducing the reservation of funds under sections 640(a)(2)(B), 640(a)(2)(D),
                   and 640(a)(2)(E) of such Act: Provided further, That $1,864,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national
                case management contract and Federal costs of administering the system: Provided further, That up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States
                to support data collection for a study of the system's effectiveness.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0101
                      Head Start
                      9,554
                      9,190
                      9,275

                      0102
                      Preschool Development Grants

                      498

                      0103
                      Runaway and homeless youth (basic centers)
                      54
                      53
                      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
                      39
                      40

                      0112
                      Child welfare services
                      268
                      267
                      269

                      0113
                      Child welfare training, research, or demonstration projects
                      18
                      18
                      18

                      0114
                      Adoption opportunities
                      39
                      39
                      39

                      0116
                      Adoption and Legal Guardianship Incentives
                      38
                      38
                      38

                      0117
                      Independent living education and training vouchers
                      43
                      43
                      43

                      0124
                      Native American programs
                      52
                      52
                      52

                      0125
                      Social services and income maintenance research
                      6
                      6
                      7

                      0128
                      ACF Federal administration
                      203
                      204
                      205

                      0131
                      Disaster human services case management
                      2
                      2
                      2

                      0191
                      Direct program activities, subtotal
                      10,440
                      10,572
                      10,165

                      0301
                      Community services block grant
                      707
                      710

                      0303
                      Rural community facilities
                      7
                      7

                      0304
                      Community economic development
                      20
                      20

                      0308
                      Domestic violence hotline
                      8
                      8
                      8

                      0309
                      Family violence prevention and services
                      151
                      150
                      151

                      0391
                      Direct program activities, subtotal
                      893
                      895
                      159

                      0400
                      Total, direct program
                      11,333
                      11,467
                      10,324

                      0799
                      Total direct obligations
                      11,333
                      11,467
                      10,324

                      0801
                      Children and Families Services Programs (Reimbursable)
                      21
                      21
                      21

                      0809
                      Reimbursable program activities, subtotal
                      21
                      21
                      21

                      0900
                      Total new obligations, unexpired accounts
                      11,354
                      11,488
                      10,345

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      426
                      330
                      81

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      426
                      330

                      1010
                      Unobligated balance transfer to other accts [075–1503]
                      –6

                      1050
                      Unobligated balance (total)
                      420
                      330
                      81

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      11,294
                      11,218
                      10,324

                      1120
                      Appropriations transferred to other accts [075–1503]
                      –39

                      1160
                      Appropriation, discretionary (total)
                      11,255
                      11,218
                      10,324

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      19
                      19
                      19

                      1701
                      Change in uncollected payments, Federal sources
                      –1

                      1750
                      Spending auth from offsetting collections, disc (total)
                      18
                      19
                      19

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      2
                      2
                      2

                      1801
                      Change in uncollected payments, Federal sources
                      1

                      1850
                      Spending auth from offsetting collections, mand (total)
                      3
                      2
                      2

                      1900
                      Budget authority (total)
                      11,276
                      11,239
                      10,345

                      1930
                      Total budgetary resources available
                      11,696
                      11,569
                      10,426

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –12

                      1941
                      Unexpired unobligated balance, end of year
                      330
                      81
                      81

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      7,620
                      8,269
                      7,693

                      3010
                      New obligations, unexpired accounts
                      11,354
                      11,488
                      10,345

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      8

                      3020
                      Outlays (gross)
                      –10,623
                      –12,064
                      –10,978

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –90

                      3050
                      Unpaid obligations, end of year
                      8,269
                      7,693
                      7,060

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –8
                      –4
                      –4

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      4

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –4
                      –4
                      –4

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      7,612
                      8,265
                      7,689

                      3200
                      Obligated balance, end of year
                      8,265
                      7,689
                      7,056

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      11,273
                      11,237
                      10,343

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      4,064
                      4,732
                      4,357

                      4011
                      Outlays from discretionary balances
                      6,557
                      7,332
                      6,621

                      4020
                      Outlays, gross (total)
                      10,621
                      12,064
                      10,978

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –22
                      –22
                      –22

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –22
                      –22
                      –22

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      1

                      4052
                      Offsetting collections credited to expired accounts
                      3
                      3
                      3

                      4060
                      Additional offsets against budget authority only (total)
                      4
                      3
                      3

                      4070
                      Budget authority, net (discretionary)
                      11,255
                      11,218
                      10,324

                      4080
                      Outlays, net (discretionary)
                      10,599
                      12,042
                      10,956

                      Mandatory:

                      4090
                      Budget authority, gross
                      3
                      2
                      2

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –2
                      –2
                      –2

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –1

                      4170
                      Outlays, net (mandatory)

                      –2
                      –2

                      4180
                      Budget authority, net (total)
                      11,255
                      11,218
                      10,324

                      4190
                      Outlays, net (total)
                      10,599
                      12,040
                      10,954

             The request totals $10.3 billion, including almost $9.3 billion for Head Start. This request discontinues funding for the
                Community Services Block Grant, Rural Community Facilities, and Community Economic Development.

          Object Classification (in millions of dollars)

                      Identification code 075–1536–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      113
                      116
                      114

                      11.3
                      Other than full-time permanent
                      4
                      4
                      4

                      11.7
                      Military personnel
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      118
                      121
                      119

                      12.1
                      Civilian personnel benefits
                      36
                      36
                      36

                      21.0
                      Travel and transportation of persons
                      3
                      3
                      3

                      23.1
                      Rental payments to GSA
                      10
                      17
                      16

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      2
                      2

                      25.1
                      Advisory and assistance services
                      235
                      238
                      237

                      25.2
                      Other services from non-Federal sources
                      9
                      9
                      8

                      25.3
                      Other goods and services from Federal sources
                      49
                      46
                      43

                      25.4
                      Operation and maintenance of facilities
                      1
                      2
                      2

                      26.0
                      Supplies and materials
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      10,870
                      10,992
                      9,857

                      99.0
                      Direct obligations
                      11,333
                      11,467
                      10,324

                      99.0
                      Reimbursable obligations
                      21
                      21
                      21

                      99.9
                      Total new obligations, unexpired accounts
                      11,354
                      11,488
                      10,345

          Employment Summary

                      Identification code 075–1536–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      1,149
                      1,142
                      1,122

                      1101
                      Direct military average strength employment
                      8
                      8
                      8

                      2001
                      Reimbursable civilian full-time equivalent employment
                      10
                      10
                      10

             Children's Research and Technical Assistance

             Program and Financing (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Training and technical assistance
                      10
                      19
                      12

                      0002
                      Federal parent locator service
                      24
                      28
                      25

                      0799
                      Total direct obligations
                      34
                      47
                      37

                      0801
                      Federal Parent Locator Service reimbursable
                      24
                      31
                      32

                      0899
                      Total reimbursable obligations
                      24
                      31
                      32

                      0900
                      Total new obligations, unexpired accounts
                      58
                      78
                      69

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      12
                      12

                      1021
                      Recoveries of prior year unpaid obligations
                      2

                      1050
                      Unobligated balance (total)
                      14
                      12

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      37
                      37
                      37

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –3
                      –2

                      1260
                      Appropriations, mandatory (total)
                      34
                      35
                      37

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      22
                      31
                      31

                      1802
                      Offsetting collections (previously unavailable)
                      1
                      1
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      22
                      31
                      32

                      1900
                      Budget authority (total)
                      56
                      66
                      69

                      1930
                      Total budgetary resources available
                      70
                      78
                      69

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      45
                      30
                      34

                      3010
                      New obligations, unexpired accounts
                      58
                      78
                      69

                      3020
                      Outlays (gross)
                      –71
                      –74
                      –83

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –2

                      3050
                      Unpaid obligations, end of year
                      30
                      34
                      20

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –6
                      –6
                      –6

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –6
                      –6
                      –6

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      39
                      24
                      28

                      3200
                      Obligated balance, end of year
                      24
                      28
                      14

                      Budget authority and outlays, net:

                      Discretionary:

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances
                      3

                      Mandatory:

                      4090
                      Budget authority, gross
                      56
                      66
                      69

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      36
                      46
                      47

                      4101
                      Outlays from mandatory balances
                      32
                      28
                      36

                      4110
                      Outlays, gross (total)
                      68
                      74
                      83

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –8
                      –9
                      –9

                      4123
                      Non-Federal sources
                      –14
                      –22
                      –22

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –22
                      –31
                      –31

                      4160
                      Budget authority, net (mandatory)
                      34
                      35
                      38

                      4170
                      Outlays, net (mandatory)
                      46
                      43
                      52

                      4180
                      Budget authority, net (total)
                      34
                      35
                      38

                      4190
                      Outlays, net (total)
                      49
                      43
                      52

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1

             This account provides funding for research and technical assistance activities established by the Personal Responsibility
                and Work Opportunity Reconciliation Act of 1996 (P.L. 104–193), as amended by the Deficit Reduction Act of 2005 (P.L. 109–171).
                A set of proposals would provide additional access to the National Directory of New Hires.

          Object Classification (in millions of dollars)

                      Identification code 075–1553–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      7
                      8
                      9

                      12.1
                      Civilian personnel benefits
                      2
                      3
                      3

                      21.0
                      Travel and transportation of persons
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      1
                      2

                      25.2
                      Other services from non-Federal sources
                      8
                      8
                      7

                      25.3
                      Other goods and services from Federal sources
                      6
                      12
                      6

                      25.7
                      Operation and maintenance of equipment
                      6
                      10
                      9

                      99.0
                      Direct obligations
                      34
                      47
                      38

                      99.0
                      Reimbursable obligations
                      24
                      31
                      31

                      99.9
                      Total new obligations, unexpired accounts
                      58
                      78
                      69

          Employment Summary

                      Identification code 075–1553–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      56
                      68
                      68

             Children's Research and Technical Assistance

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

                      Identification code 075–1553–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Federal Parent Locator Service reimbursable

                      3

                      0899
                      Total reimbursable obligations

                      3

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      3

                      1900
                      Budget authority (total)

                      3

                      1930
                      Total budgetary resources available

                      3

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      3

                      3020
                      Outlays (gross)

                      –3

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      3

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      3

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –3

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

          Object Classification (in millions of dollars)

                      Identification code 075–1553–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      25.1
                      Advisory and assistance services

                      1

                      25.3
                      Other goods and services from Federal sources

                      2

                      99.0
                      Reimbursable obligations

                      3

                      99.9
                      Total new obligations, unexpired accounts

                      3

          Employment Summary

                      Identification code 075–1553–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      2

             Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, $6,035,000,000.
          For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year 2020, $2,800,000,000.
          For carrying out, after May 31 of the current fiscal year, except as otherwise provided, section 474 of title IV-E of the
                Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal
                year, such sums as may be necessary.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Foster care
                      5,363
                      5,278
                      5,329

                      0002
                      Independent living
                      140
                      140
                      140

                      0004
                      Adoption assistance
                      2,706
                      2,861
                      3,063

                      0005
                      Guardianship
                      145
                      186
                      203

                      0006
                      Technical Assistance and Implementation Services for Tribal Programs
                      3
                      3
                      3

                      0900
                      Total new obligations, unexpired accounts
                      8,357
                      8,468
                      8,738

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      6,059
                      5,969
                      6,038

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced
                      –2
                      –1

                      1260
                      Appropriations, mandatory (total)
                      6,057
                      5,968
                      6,038

                      Advance appropriations, mandatory:

                      1270
                      Advance appropriation
                      2,300
                      2,500
                      2,700

                      1900
                      Budget authority (total)
                      8,357
                      8,468
                      8,738

                      1930
                      Total budgetary resources available
                      8,357
                      8,468
                      8,738

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,113
                      1,611
                      1,813

                      3010
                      New obligations, unexpired accounts
                      8,357
                      8,468
                      8,738

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      69

                      3020
                      Outlays (gross)
                      –7,712
                      –8,266
                      –8,597

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –216

                      3050
                      Unpaid obligations, end of year
                      1,611
                      1,813
                      1,954

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,113
                      1,611
                      1,813

                      3200
                      Obligated balance, end of year
                      1,611
                      1,813
                      1,954

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      8,357
                      8,468
                      8,738

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6,961
                      7,380
                      7,619

                      4101
                      Outlays from mandatory balances
                      751
                      886
                      978

                      4110
                      Outlays, gross (total)
                      7,712
                      8,266
                      8,597

                      4180
                      Budget authority, net (total)
                      8,357
                      8,468
                      8,738

                      4190
                      Outlays, net (total)
                      7,712
                      8,266
                      8,597

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

                      2017 actual
                      2018 est.
                      2019 est.

                      Enacted/requested:

                      Budget Authority
                      8,357
                      8,468
                      8,738

                      Outlays
                      7,712
                      8,266
                      8,597

                      Legislative proposal, subject to PAYGO:

                      Budget Authority

                      18

                      Outlays

                      18

                      Total:

                      Budget Authority
                      8,357
                      8,468
                      8,756

                      Outlays
                      7,712
                      8,266
                      8,615

             This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, and the Chafee
                Foster Care Independence Program, as well as technical assistance and implementation services for tribal programs.

             Foster Care—The proposed level will support eligible low-income children who must be placed outside the home. An average of 171,400 children
                per month are estimated to be served in FY 2019.

             Adoption Assistance—The proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
                An average of 496,300 children per month are estimated to be served in FY 2019.

             Guardianship Assistance Program—The proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
                in foster care. An average of 35,600 children per month are estimated to be served in FY 2019.

             The Budget includes proposals to create the Child Welfare Flexible Funding Option for title IV-E agencies, create a performance
                incentive for achieving or exceeding Child and Family Services Reviews outcomes, reform the requirement for title IV-E agencies
                to calculate the savings in costs based on obsolete adoption program criteria, and authorize tribal titles IV-B and IV-E agencies
                to access certain information from the Federal Parent Locator Service. Additionally, the Budget includes the interaction effects
                from the proposal to eliminate SSBG funding, which increases costs in FCP due to State agencies shifting eligible expenses
                previously funded by SSBG to FCP.

          Object Classification (in millions of dollars)

                      Identification code 075–1545–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      21.0
                      Travel and transportation of persons

                      1
                      1

                      23.1
                      Rental payments to GSA
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      32
                      34
                      35

                      25.2
                      Other services from non-Federal sources
                      1

                      41.0
                      Grants, subsidies, and contributions
                      8,323
                      8,432
                      8,701

                      99.9
                      Total new obligations, unexpired accounts
                      8,357
                      8,468
                      8,738

          Employment Summary

                      Identification code 075–1545–0–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      3
                      4
                      4

             Payments for Foster Care and Permanency

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

                      Identification code 075–1545–4–1–609
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Foster care

                      4

                      0004
                      Adoption assistance

                      13

                      0005
                      Guardianship

                      1

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

                      18

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation

                      18

                      1900
                      Budget authority (total)

                      18

                      1930
                      Total budgetary resources available

                      18

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      18

                      3020
                      Outlays (gross)

                      –18

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      18

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      18

                      4180
                      Budget authority, net (total)

                      18

                      4190
                      Outlays, net (total)

                      18

             Administration for Community Living

             Federal Funds
             aging and disability services programs
             (including transfer of funds)For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), titles III and XXIX of the
                PHS Act, sections 1252 and 1253 of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of
                2008, title XX-B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and
                5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive Technology Act of 1998, title VII (and section 14 with respect to such title) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals with disabilities, $1,781,181,000: 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 of amounts made available under this heading to carry out sections 311, 331, and 336 of the OAA, up
                   to one percent of such amounts shall be available for developing and implementing evidence-based practices for enhancing senior
                   nutrition: Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of
                the OAA may be transferred to the Secretary of Agriculture in accordance with such section: Provided further, That none of the funds made available under this heading may be used by an eligible system (as defined in section 102 of
                the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action
                in a Federal or State court on behalf of an individual or group of individuals with a developmental disability (as defined
                in section 102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A))
                that is attributable to a mental impairment (or a combination of mental and physical impairments), that has as the requested
                remedy the closure of State operated intermediate care facilities for people with intellectual or developmental disabilities,
                unless reasonable public notice of the action has been provided to such individuals (or, in the case of mental incapacitation,
                the legal guardians who have been specifically awarded authority by the courts to make healthcare and residential decisions
                on behalf of such individuals) who are affected by such action, within 90 days of instituting such legal action, which informs
                such individuals (or such legal guardians) of their legal rights and how to exercise such rights consistent with current Federal
                Rules of Civil Procedure: Provided further, That the limitations in the immediately preceding proviso shall not apply in the case of an individual who is neither competent
                to consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who are a ward of the State or
                subject to public guardianship.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0101
                      Aging Services Programs
                      1,468
                      1,438
                      1,463

                      0102
                      ACL Program Administration
                      39
                      39
                      38

                      0103
                      Integrated Aging and Disability Services Programs
                      43
                      43
                      41

                      0104
                      Disability Services Programs
                      284
                      283
                      239

                      0105
                      National Institute on Disability, Independent Living & Rehab Research
                      104
                      103

                      0300
                      Total, direct program
                      1,938
                      1,906
                      1,781

                      0799
                      Total direct obligations
                      1,938
                      1,906
                      1,781

                      0801
                      ACL Reimbursable Programs
                      90
                      90
                      18

                      0900
                      Total new obligations, unexpired accounts
                      2,028
                      1,996
                      1,799

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      3
                      7
                      30

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      5
                      7
                      30

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      1,919
                      1,906
                      1,781

                      1120
                      Appropriations transferred to other accts [012–3507]
                      –3

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –4

                      1121
                      Appropriations transferred from other acct [075–0116]

                      25

                      1160
                      Appropriation, discretionary (total)
                      1,912
                      1,931
                      1,781

                      Appropriations, mandatory:

                      1221
                      PPHF Appropriations transferred from other accounts [075–0116]
                      28

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      7
                      65
                      18

                      1701
                      Change in uncollected payments, Federal sources
                      60

                      1750
                      Spending auth from offsetting collections, disc (total)
                      67
                      65
                      18

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      1
                      23

                      1801
                      Change in uncollected payments, Federal sources
                      23

                      1850
                      Spending auth from offsetting collections, mand (total)
                      24
                      23

                      1900
                      Budget authority (total)
                      2,031
                      2,019
                      1,799

                      1930
                      Total budgetary resources available
                      2,036
                      2,026
                      1,829

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      7
                      30
                      30

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      1,261
                      1,269
                      1,224

                      3010
                      New obligations, unexpired accounts
                      2,028
                      1,996
                      1,799

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      8

                      3020
                      Outlays (gross)
                      –1,995
                      –2,041
                      –1,984

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –32

                      3050
                      Unpaid obligations, end of year
                      1,269
                      1,224
                      1,039

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –163
                      –153
                      –153

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –83

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      93

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –153
                      –153
                      –153

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      1,098
                      1,116
                      1,071

                      3200
                      Obligated balance, end of year
                      1,116
                      1,071
                      886

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,979
                      1,996
                      1,799

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      1,013
                      1,214
                      1,126

                      4011
                      Outlays from discretionary balances
                      934
                      751
                      815

                      4020
                      Outlays, gross (total)
                      1,947
                      1,965
                      1,941

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –97
                      –65
                      –18

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –60

                      4052
                      Offsetting collections credited to expired accounts
                      90

                      4060
                      Additional offsets against budget authority only (total)
                      30

                      4070
                      Budget authority, net (discretionary)
                      1,912
                      1,931
                      1,781

                      4080
                      Outlays, net (discretionary)
                      1,850
                      1,900
                      1,923

                      Mandatory:

                      4090
                      Budget authority, gross
                      52
                      23

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      1
                      5

                      4101
                      Outlays from mandatory balances
                      47
                      71
                      43

                      4110
                      Outlays, gross (total)
                      48
                      76
                      43

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –2
                      –23

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –23

                      4142
                      Offsetting collections credited to expired accounts
                      1

                      4150
                      Additional offsets against budget authority only (total)
                      –22

                      4160
                      Budget authority, net (mandatory)
                      28

                      4170
                      Outlays, net (mandatory)
                      46
                      53
                      43

                      4180
                      Budget authority, net (total)
                      1,940
                      1,931
                      1,781

                      4190
                      Outlays, net (total)
                      1,896
                      1,953
                      1,966

             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.

          Object Classification (in millions of dollars)

                      Identification code 075–0142–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      22
                      21
                      17

                      12.1
                      Civilian personnel benefits
                      7
                      6
                      6

                      23.1
                      Rental payments to GSA
                      2
                      3
                      3

                      25.1
                      Advisory and assistance services
                      41
                      33
                      31

                      41.0
                      Grants, subsidies, and contributions
                      1,867
                      1,843
                      1,724

                      99.0
                      Direct obligations
                      1,939
                      1,906
                      1,781

                      99.0
                      Reimbursable obligations
                      89
                      90
                      18

                      99.9
                      Total new obligations, unexpired accounts
                      2,028
                      1,996
                      1,799

          Employment Summary

                      Identification code 075–0142–0–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      181
                      170
                      139

                      2001
                      Reimbursable civilian full-time equivalent employment
                      15
                      13
                      10

             Aging and Disability Services Programs

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

                      Identification code 075–0142–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0103
                      Integrated Aging and Disability Services Programs

                      25
                      25

                      0300
                      Total, direct program

                      25
                      25

                      0799
                      Total direct obligations

                      25
                      25

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      25
                      25

                      1900
                      Budget authority (total)

                      25
                      25

                      1930
                      Total budgetary resources available

                      25
                      25

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      25
                      25

                      3020
                      Outlays (gross)

                      –25
                      –25

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      25
                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      25
                      25

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –25
                      –25

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The Budget extends mandatory funding for ACL's Medicare Enrollment Assistance Programs through fiscal year 2019.

          Object Classification (in millions of dollars)

                      Identification code 075–0142–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      1
                      1

                      41.0
                      Grants, subsidies, and contributions

                      24
                      24

                      99.0
                      Direct obligations

                      25
                      25

                      99.9
                      Total new obligations, unexpired accounts

                      25
                      25

          Employment Summary

                      Identification code 075–0142–4–1–506
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      4
                      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, $289,545,000, together with $53,445,000 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 funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through
                grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4).
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      General Departmental Management
                      461
                      458
                      290

                      0801
                      GDM Collected (Reimbursable)
                      153
                      195
                      191

                      0802
                      HCFAC (Mandatory)
                      7
                      7
                      10

                      0803
                      PHS Evaluation (Collected)
                      64
                      64
                      53

                      0804
                      MACRA (Mandatory)
                      5
                      5
                      5

                      0899
                      Total reimbursable obligations
                      229
                      271
                      259

                      0900
                      Total new obligations, unexpired accounts
                      690
                      729
                      549

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      10
                      11
                      11

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      10

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      461
                      458
                      290

                      1120
                      Appropriations transferred to other accts [075–1503]
                      –1

                      1160
                      Appropriation, discretionary (total)
                      460
                      458
                      290

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      57
                      259
                      244

                      1701
                      Change in uncollected payments, Federal sources
                      163

                      1750
                      Spending auth from offsetting collections, disc (total)
                      220
                      259
                      244

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      12
                      15

                      1801
                      Change in uncollected payments, Federal sources
                      12

                      1850
                      Spending auth from offsetting collections, mand (total)
                      12
                      12
                      15

                      1900
                      Budget authority (total)
                      692
                      729
                      549

                      1930
                      Total budgetary resources available
                      702
                      740
                      560

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      11
                      11
                      11

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      517
                      467
                      577

                      3010
                      New obligations, unexpired accounts
                      690
                      729
                      549

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      10

                      3020
                      Outlays (gross)
                      –716
                      –619
                      –730

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –34

                      3050
                      Unpaid obligations, end of year
                      467
                      577
                      396

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –230
                      –296
                      –296

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –175

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      109

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –296
                      –296
                      –296

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      287
                      171
                      281

                      3200
                      Obligated balance, end of year
                      171
                      281
                      100

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      680
                      717
                      534

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      356
                      344
                      262

                      4011
                      Outlays from discretionary balances
                      349
                      263
                      453

                      4020
                      Outlays, gross (total)
                      705
                      607
                      715

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –158
                      –259
                      –244

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –158
                      –259
                      –244

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –163

                      4052
                      Offsetting collections credited to expired accounts
                      101

                      4060
                      Additional offsets against budget authority only (total)
                      –62

                      4070
                      Budget authority, net (discretionary)
                      460
                      458
                      290

                      4080
                      Outlays, net (discretionary)
                      547
                      348
                      471

                      Mandatory:

                      4090
                      Budget authority, gross
                      12
                      12
                      15

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      6
                      12
                      15

                      4101
                      Outlays from mandatory balances
                      5

                      4110
                      Outlays, gross (total)
                      11
                      12
                      15

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources:
                      –3
                      –12
                      –15

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      –12

                      4142
                      Offsetting collections credited to expired accounts
                      3

                      4150
                      Additional offsets against budget authority only (total)
                      –9

                      4170
                      Outlays, net (mandatory)
                      8

                      4180
                      Budget authority, net (total)
                      460
                      458
                      290

                      4190
                      Outlays, net (total)
                      555
                      348
                      471

             Note.—The reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
                for 2019. Actual allocation will be determined annually.

             General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
                to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
                activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
                promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
                Prevention and Public Health Fund.

          Object Classification (in millions of dollars)

                      Identification code 075–9912–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      86
                      87
                      88

                      11.3
                      Other than full-time permanent
                      10
                      10
                      10

                      11.5
                      Other personnel compensation
                      2
                      2
                      2

                      11.7
                      Military personnel
                      3
                      3
                      3

                      11.9
                      Total personnel compensation
                      101
                      102
                      103

                      12.1
                      Civilian personnel benefits
                      28
                      29
                      29

                      12.2
                      Military personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      4
                      4
                      4

                      23.1
                      Rental payments to GSA
                      17
                      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
                      22
                      21
                      16

                      25.2
                      Other services from non-Federal sources
                      45
                      45
                      28

                      25.3
                      Other goods and services from Federal sources
                      70
                      67
                      31

                      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
                      2
                      2
                      2

                      31.0
                      Equipment
                      2
                      2
                      2

                      41.0
                      Grants, subsidies, and contributions
                      155
                      155
                      44

                      99.0
                      Direct obligations
                      461
                      458
                      290

                      99.0
                      Reimbursable obligations
                      229
                      271
                      259

                      99.9
                      Total new obligations, unexpired accounts
                      690
                      729
                      549

          Employment Summary

                      Identification code 075–9912–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      899
                      965
                      978

                      1101
                      Direct military average strength employment
                      18
                      27
                      27

                      2001
                      Reimbursable civilian full-time equivalent employment
                      503
                      529
                      504

                      2101
                      Reimbursable military average strength employment
                      22
                      24
                      24

             General Departmental Management

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

                      Identification code 075–9912–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0804
                      DAB (Mandatory Proposal and User Fee Collections)

                      4

                      0899
                      Total reimbursable obligations

                      4

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      4

                      1930
                      Total budgetary resources available

                      4

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      4

                      3020
                      Outlays (gross)

                      –4

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      4

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      4

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –4

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             Legislative proposals provide the Departmental Appeals Board (DAB) mandatory resources to address the Medicare appeals backlog.

          Object Classification (in millions of dollars)

                      Identification code 075–9912–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      11.1
                      Reimbursable obligations: Personnel compensation: Full-time permanent

                      2

                      11.9
                      Total personnel compensation

                      2

                      25.3
                      Other goods and services from Federal sources

                      2

                      99.0
                      Reimbursable obligations

                      4

                      99.9
                      Total new obligations, unexpired accounts

                      4

          Employment Summary

                      Identification code 075–9912–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      2001
                      Reimbursable civilian full-time equivalent employment

                      14

             Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act

             Program and Financing (in millions of dollars)

                      Identification code 075–0146–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Opioid Funding
                      500
                      500

                      0900
                      Total new obligations, unexpired accounts (object class 94.0)
                      500
                      500

                      Budgetary resources:

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      500
                      500

                      1930
                      Total budgetary resources available
                      500
                      500

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      500
                      500

                      3020
                      Outlays (gross)
                      –500
                      –500

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      500
                      500

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      500
                      500

                      4180
                      Budget authority, net (total)
                      500
                      500

                      4190
                      Outlays, net (total)
                      500
                      500

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

             State Response to the Opioid Abuse Crisis, CURES Act

          Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      3

                      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
                      3

                      Appropriations:

                      Current law:

                      2101
                      State Response to the Opioid Abuse Crisis, Cures Act
                      –500
                      –497

                      5099
                      Balance, end of year

                      3
                      3

          Program and Financing (in millions of dollars)

                      Identification code 075–5627–0–2–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1101
                      Appropriation (special or trust fund)
                      500
                      497

                      1120
                      Appropriations transferred to other acct [075–1362]
                      –500
                      –497

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The 21st Century Cures Act authorized in 2017 and 2018 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, $30,904,000.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Office for Civil Rights (Direct)
                      39
                      39
                      31

                      0801
                      Office for Civil Rights (Reimbursable)
                      8
                      9
                      13

                      0900
                      Total new obligations, unexpired accounts
                      47
                      48
                      44

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      24
                      36
                      37

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

                      1050
                      Unobligated balance (total)
                      23
                      36
                      37

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      39
                      39
                      31

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      20
                      10
                      10

                      1802
                      Offsetting collections (previously unavailable)
                      2

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      21
                      10
                      10

                      1900
                      Budget authority (total)
                      60
                      49
                      41

                      1930
                      Total budgetary resources available
                      83
                      85
                      78

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      36
                      37
                      34

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      14
                      18
                      19

                      3010
                      New obligations, unexpired accounts
                      47
                      48
                      44

                      3020
                      Outlays (gross)
                      –43
                      –47
                      –44

                      3050
                      Unpaid obligations, end of year
                      18
                      19
                      19

                      Uncollected payments:

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

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      1

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      13
                      18
                      19

                      3200
                      Obligated balance, end of year
                      18
                      19
                      19

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      39
                      39
                      31

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      33
                      31
                      25

                      4011
                      Outlays from discretionary balances
                      4
                      7
                      8

                      4020
                      Outlays, gross (total)
                      37
                      38
                      33

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –1

                      Additional offsets against gross budget authority only:

                      4052
                      Offsetting collections credited to expired accounts
                      1

                      4060
                      Additional offsets against budget authority only (total)
                      1

                      4070
                      Budget authority, net (discretionary)
                      39
                      39
                      31

                      4080
                      Outlays, net (discretionary)
                      36
                      38
                      33

                      Mandatory:

                      4090
                      Budget authority, gross
                      21
                      10
                      10

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1
                      1

                      4101
                      Outlays from mandatory balances
                      6
                      8
                      10

                      4110
                      Outlays, gross (total)
                      6
                      9
                      11

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4123
                      Non-Federal sources
                      –20
                      –10
                      –10

                      4180
                      Budget authority, net (total)
                      40
                      39
                      31

                      4190
                      Outlays, net (total)
                      22
                      37
                      34

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1
                      1

             The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination, health information
                privacy, and security compliance programs.

          Object Classification (in millions of dollars)

                      Identification code 075–0135–0–1–751
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      16
                      17
                      16

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      17
                      18
                      17

                      12.1
                      Civilian personnel benefits
                      6
                      6
                      6

                      23.1
                      Rental payments to GSA
                      3
                      3
                      3

                      25.3
                      Other goods and services from Federal sources
                      11
                      10
                      4

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1

                      99.0
                      Direct obligations
                      39
                      39
                      31

                      99.0
                      Reimbursable obligations
                      8
                      9
                      13

                      99.9
                      Total new obligations, unexpired accounts
                      47
                      48
                      44

          Employment Summary

                      Identification code 075–0135–0–1–751
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      149
                      152
                      147

                      1101
                      Direct military average strength employment
                      1
                      1
                      1

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1
                      1
                      1

             Office of the national coordinator for health information technologyFor expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts,
                and cooperative agreements for the development and advancement of interoperable health information technology, $38,381,000.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Health information technology (IT)
                      60
                      60
                      38

                      0002
                      Recovery Act activities
                      2

                      0799
                      Total direct obligations
                      62
                      60
                      38

                      0801
                      Office of the National Coordinator for Health IT (ONC): Reimbursable
                      19
                      19
                      15

                      0899
                      Total reimbursable obligations
                      19
                      19
                      15

                      0900
                      Total new obligations, unexpired accounts
                      81
                      79
                      53

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      2
                      1
                      1

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      60
                      60
                      38

                      Spending authority from offsetting collections, discretionary:

                      1700
                      PHS and Other
                      9
                      19
                      15

                      1701
                      Change in uncollected payments, Federal sources
                      11

                      1750
                      Spending auth from offsetting collections, disc (total)
                      20
                      19
                      15

                      1900
                      Budget authority (total)
                      80
                      79
                      53

                      1930
                      Total budgetary resources available
                      82
                      80
                      54

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1
                      1
                      1

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      93
                      68
                      26

                      3010
                      New obligations, unexpired accounts
                      81
                      79
                      53

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

                      3020
                      Outlays (gross)
                      –105
                      –121
                      –61

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –2

                      3050
                      Unpaid obligations, end of year
                      68
                      26
                      18

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –27
                      –23
                      –23

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –11

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      15

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –23
                      –23
                      –23

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      66
                      45
                      3

                      3200
                      Obligated balance, end of year
                      45
                      3
                      –5

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      80
                      79
                      53

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      51
                      67
                      45

                      4011
                      Outlays from discretionary balances
                      54
                      54
                      16

                      4020
                      Outlays, gross (total)
                      105
                      121
                      61

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources:
                      –24
                      –19
                      –15

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –24
                      –19
                      –15

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –11

                      4052
                      Offsetting collections credited to expired accounts
                      15

                      4060
                      Additional offsets against budget authority only (total)
                      4

                      4070
                      Budget authority, net (discretionary)
                      60
                      60
                      38

                      4080
                      Outlays, net (discretionary)
                      81
                      102
                      46

                      4180
                      Budget authority, net (total)
                      60
                      60
                      38

                      4190
                      Outlays, net (total)
                      81
                      102
                      46

             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 authorized
                in Title XXX of the PHS Act as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L.
                111–5, Title XIII) and the 21st Century Cures Act (P.L. 114–255), for the purpose of addressing strategic planning, coordination,
                and the analysis of key technical, economic and other issues related to the public and private adoption of health information
                technology.

          Object Classification (in millions of dollars)

                      Identification code 075–0130–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      18
                      17
                      17

                      11.3
                      Other than full-time permanent
                      2
                      2
                      2

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      21
                      20
                      20

                      12.1
                      Civilian personnel benefits
                      6
                      5
                      4

                      23.1
                      Rental payments to GSA
                      4
                      2
                      2

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.1
                      Advisory and assistance services
                      1

                      25.2
                      Other services from non-Federal sources
                      12
                      15
                      5

                      25.3
                      Other goods and services from Federal sources
                      13
                      16
                      6

                      25.4
                      Operation and maintenance of facilities
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      1

                      99.0
                      Direct obligations
                      60
                      60
                      38

                      99.0
                      Reimbursable obligations
                      21
                      19
                      15

                      99.9
                      Total new obligations, unexpired accounts
                      81
                      79
                      53

          Employment Summary

                      Identification code 075–0130–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      185
                      162
                      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, $112,381,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
                Insurance Trust Fund: Provided, That, in addition, of the amounts the Secretary retains for adjudications related to Recovery Audit Contractor
                   (RAC) appeals under section 1893(h)(1)(C) of the Social Security Act, $10,000,000 shall be used as additional funds for the
                   necessary expenses of the Office of Medicare Hearings and Appeals and the Departmental Appeals Board to process RAC-related
                   appeals.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0139–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Office of Medicare Hearings and Appeals (Direct)
                      107
                      107
                      112

                      0799
                      Total direct obligations
                      107
                      107
                      112

                      0801
                      Office of Medicare Hearings and Appeals (RAC Mandatory)

                      10

                      0900
                      Total new obligations, unexpired accounts
                      107
                      107
                      122

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      86
                      107
                      112

                      1701
                      Change in uncollected payments, Federal sources
                      21

                      1750
                      Spending auth from offsetting collections, disc (total)
                      107
                      107
                      112

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      10

                      1900
                      Budget authority (total)
                      107
                      107
                      122

                      1930
                      Total budgetary resources available
                      107
                      107
                      122

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      30
                      28

                      3010
                      New obligations, unexpired accounts
                      107
                      107
                      122

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

                      3020
                      Outlays (gross)
                      –106
                      –135
                      –122

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –4

                      3050
                      Unpaid obligations, end of year
                      28

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –43
                      –39
                      –39

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –21

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      25

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –39
                      –39
                      –39

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –13
                      –11
                      –39

                      3200
                      Obligated balance, end of year
                      –11
                      –39
                      –39

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      107
                      107
                      112

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      91
                      107
                      112

                      4011
                      Outlays from discretionary balances
                      15
                      28

                      4020
                      Outlays, gross (total)
                      106
                      135
                      112

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –111
                      –107
                      –112

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –21

                      4052
                      Offsetting collections credited to expired accounts
                      25

                      4060
                      Additional offsets against budget authority only (total)
                      4

                      4080
                      Outlays, net (discretionary)
                      –5
                      28

                      Mandatory:

                      4090
                      Budget authority, gross

                      10

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      10

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –10

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –5
                      28

             This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare
                Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides an independent and impartial forum for the adjudication
                of claims brought by or on behalf of Medicare beneficiaries related to their benefits and care.

          Object Classification (in millions of dollars)

                      Identification code 075–0139–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      55
                      61
                      63

                      11.5
                      Other personnel compensation

                      1
                      1

                      11.9
                      Total personnel compensation
                      55
                      62
                      64

                      12.1
                      Civilian personnel benefits
                      18
                      20
                      21

                      23.1
                      Rental payments to GSA
                      8
                      7
                      7

                      23.3
                      Communications, utilities, and miscellaneous charges
                      3
                      4
                      4

                      25.2
                      Other services from non-Federal sources
                      10
                      1
                      2

                      25.3
                      Other goods and services from Federal sources
                      9
                      10
                      11

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      25.7
                      Operation and maintenance of equipment
                      1
                      1
                      1

                      26.0
                      Supplies and materials
                      1

                      1

                      31.0
                      Equipment
                      1
                      1

                      99.0
                      Direct obligations
                      107
                      107
                      112

                      99.0
                      Reimbursable obligations

                      10

                      99.9
                      Total new obligations, unexpired accounts
                      107
                      107
                      122

          Employment Summary

                      Identification code 075–0139–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      603
                      690
                      705

                      2001
                      Reimbursable civilian full-time equivalent employment

                      45

             Office of Medicare Hearings and Appeals

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

                      Identification code 075–0139–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Reimbursable program activity

                      129

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected

                      129

                      1930
                      Total budgetary resources available

                      129

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts

                      129

                      3020
                      Outlays (gross)

                      –129

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross

                      129

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      129

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –129

                      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. An additional legislative proposal would establish a post-adjudication user fee for Medicare Parts A and
                B claim appeals filed by a provider or supplier, or a State Medicaid Agency, with respect to appeals that are unfavorable
                to the appellant and for appeals that are dismissed.

          Object Classification (in millions of dollars)

                      Identification code 075–0139–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      11.1
                      Personnel compensation: Full-time permanent

                      28

                      12.1
                      Civilian personnel benefits

                      9

                      22.0
                      Transportation of things

                      1

                      23.1
                      Rental payments to GSA

                      4

                      23.3
                      Communications, utilities, and miscellaneous charges

                      8

                      25.2
                      Other services from non-Federal sources

                      25

                      25.3
                      Other goods and services from Federal sources

                      9

                      25.4
                      Operation and maintenance of facilities

                      38

                      26.0
                      Supplies and materials

                      2

                      31.0
                      Equipment

                      5

                      99.9
                      Total new obligations, unexpired accounts

                      129

          Employment Summary

                      Identification code 075–0139–4–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment

                      200

             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, $941,523,000, 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, 2021: 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) and for carrying out section 319F-2(a) of the PHS Act, $1,085,000,000, 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, $202,378,000; of which $162,378,000 shall be available until expended, for activities including the development and purchase of vaccines, antivirals, necessary
                medical supplies, diagnostics, and other surveillance tools: Provided, That  funds may be used for the construction or renovation of privately owned facilities for the production of pandemic influenza
                vaccines and other biologics, if the Secretary finds such construction or renovation necessary to secure sufficient supplies
                of such vaccines or biologics.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0140–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Public Health and Social Services Emergency Fund
                      2,307
                      1,597
                      2,229

                      0100
                      Direct program activities, subtotal
                      2,307
                      1,597
                      2,229

                      0801
                      Reimbursable program (FEMA)
                      76
                      104
                      104

                      0802
                      Reimbursable program activity (OPP)
                      2
                      2
                      2

                      0899
                      Total reimbursable obligations
                      78
                      106
                      106

                      0900
                      Total new obligations, unexpired accounts
                      2,385
                      1,703
                      2,335

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      945
                      123
                      63

                      1010
                      Unobligated balance transfer to other accts [075–0128]
                      –1

                      1010
                      Unobligated balance transfer to other accts [075–0343]
                      –2
                      –2
                      –3

                      1010
                      Unobligated balance transfer to other accts [075–0943]
                      –23

                      1010
                      Unobligated balance transfer to other accts [075–9915]
                      –66

                      1021
                      Recoveries of prior year unpaid obligations
                      64

                      1050
                      Unobligated balance (total)
                      917
                      121
                      60

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      1,518
                      1,563
                      2,229

                      1120
                      Appropriations transferred to other acct [075–1503]
                      –4

                      1160
                      Appropriation, discretionary (total)
                      1,514
                      1,563
                      2,229

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      3
                      82
                      82

                      1701
                      Change in uncollected payments, Federal sources
                      75

                      1750
                      Spending auth from offsetting collections, disc (total)
                      78
                      82
                      82

                      1900
                      Budget authority (total)
                      1,592
                      1,645
                      2,311

                      1930
                      Total budgetary resources available
                      2,509
                      1,766
                      2,371

                      Memorandum (non-add) entries:

                      1940
                      Unobligated balance expiring
                      –1

                      1941
                      Unexpired unobligated balance, end of year
                      123
                      63
                      36

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      4,268
                      4,745
                      1,899

                      3010
                      New obligations, unexpired accounts
                      2,385
                      1,703
                      2,335

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

                      3020
                      Outlays (gross)
                      –1,821
                      –4,549
                      –3,073

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –64

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –35

                      3050
                      Unpaid obligations, end of year
                      4,745
                      1,899
                      1,161

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –80
                      –107
                      –107

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –75

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      48

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –107
                      –107
                      –107

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      4,188
                      4,638
                      1,792

                      3200
                      Obligated balance, end of year
                      4,638
                      1,792
                      1,054

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,592
                      1,645
                      2,311

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      283
                      1,641
                      2,306

                      4011
                      Outlays from discretionary balances
                      1,538
                      2,908
                      767

                      4020
                      Outlays, gross (total)
                      1,821
                      4,549
                      3,073

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –20
                      –82
                      –82

                      4033
                      Non-Federal sources
                      –31

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –51
                      –82
                      –82

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –75

                      4052
                      Offsetting collections credited to expired accounts
                      48

                      4060
                      Additional offsets against budget authority only (total)
                      –27

                      4070
                      Budget authority, net (discretionary)
                      1,514
                      1,563
                      2,229

                      4080
                      Outlays, net (discretionary)
                      1,770
                      4,467
                      2,991

                      4180
                      Budget authority, net (total)
                      1,514
                      1,563
                      2,229

                      4190
                      Outlays, net (total)
                      1,770
                      4,467
                      2,991

             The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare
                for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding
                for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized by the Pandemic and All-Hazards
                Preparedness Reauthorization Act of 2013. Funds will be used for hospital preparedness and other emergency preparedness activities
                including the National Disaster Medical System. The PHSSEF continues to support the advanced development and procurement of
                biodefense and pandemic influenza countermeasures. The FY 2019 Budget reflects the transfer of the Strategic National Stockpile
                (SNS) from the Centers for Disease Control and Prevention to ASPR.

             The PHSSEF also supports the HHS Cybersecurity program, National Security and Strategic Information programs, and the Medical
                Reserve Corps.

          Object Classification (in millions of dollars)

                      Identification code 075–0140–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      73
                      88
                      126

                      11.3
                      Other than full-time permanent
                      18

                      11.7
                      Military personnel
                      8
                      9
                      8

                      11.9
                      Total personnel compensation
                      99
                      97
                      134

                      12.1
                      Civilian personnel benefits
                      25
                      32
                      46

                      12.2
                      Military personnel benefits
                      4
                      3
                      3

                      21.0
                      Travel and transportation of persons
                      8
                      6
                      17

                      22.0
                      Transportation of things
                      1

                      1

                      23.1
                      Rental payments to GSA
                      15
                      8
                      29

                      23.3
                      Communications, utilities, and miscellaneous charges
                      6
                      5
                      4

                      25.1
                      Advisory and assistance services
                      904
                      745
                      474

                      25.2
                      Other services from non-Federal sources
                      236
                      199
                      116

                      25.3
                      Other goods and services from Federal sources
                      69
                      54
                      222

                      25.4
                      Operation and maintenance of facilities
                      6
                      1
                      15

                      25.5
                      Research and development contracts
                      178
                      1
                      754

                      25.7
                      Operation and maintenance of equipment
                      21
                      18
                      91

                      26.0
                      Supplies and materials
                      449
                      358
                      38

                      31.0
                      Equipment
                      2
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      284
                      69
                      284

                      99.0
                      Direct obligations
                      2,307
                      1,597
                      2,229

                      99.0
                      Reimbursable obligations
                      78
                      106
                      106

                      99.9
                      Total new obligations, unexpired accounts
                      2,385
                      1,703
                      2,335

          Employment Summary

                      Identification code 075–0140–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      656
                      705
                      940

                      1101
                      Direct military average strength employment
                      75
                      75
                      75

             Transfers from the Patient-Centered Outcomes Research Trust Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      AHRQ
                      57

                      0002
                      Office of the Secretary
                      26
                      28
                      27

                      0003
                      NIRSQ

                      79
                      50

                      0900
                      Total new obligations, unexpired accounts
                      83
                      107
                      77

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      55
                      88
                      106

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      56
                      88
                      106

                      Budget authority:

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      115
                      125
                      155

                      1930
                      Total budgetary resources available
                      171
                      213
                      261

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      88
                      106
                      184

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      152
                      122
                      197

                      3010
                      New obligations, unexpired accounts
                      83
                      107
                      77

                      3020
                      Outlays (gross)
                      –112
                      –32
                      –98

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      122
                      197
                      176

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      152
                      122
                      197

                      3200
                      Obligated balance, end of year
                      122
                      197
                      176

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      115
                      125
                      155

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      2
                      4
                      5

                      4101
                      Outlays from mandatory balances
                      110
                      28
                      93

                      4110
                      Outlays, gross (total)
                      112
                      32
                      98

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –115
                      –125
                      –155

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –3
                      –93
                      –57

             Public Law 111–148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
                20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and
                Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
                from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
                and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research.
                Transferred funds were distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out
                these activities. The FY 2019 Budget consolidates the Agency for Healthcare Research and Quality within the National Institutes
                of Health as the National Institute for Research on Safety and Quality. This Institute is proposed to receive the resources
                from the PCORTF that the Agency for Healthcare Research and Quality would have received under current law.

          Object Classification (in millions of dollars)

                      Identification code 075–0145–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      11.1
                      Personnel compensation: Full-time permanent
                      3
                      3
                      3

                      25.1
                      Advisory and assistance services
                      7
                      30
                      26

                      25.3
                      Other goods and services from Federal sources
                      22
                      31
                      31

                      41.0
                      Grants, subsidies, and contributions
                      51
                      43
                      17

                      99.9
                      Total new obligations, unexpired accounts
                      83
                      107
                      77

          Employment Summary

                      Identification code 075–0145–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      5
                      5
                      5

             Nonrecurring Expenses Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0125–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Nonrecurring Expenses Fund Projects
                      526
                      397
                      175

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      830
                      565
                      693

                      1010
                      Unobligated balance transfer to other accts [075–1503]
                      –300

                      1012
                      Unobligated balance transfers between expired and unexpired accounts
                      652
                      525
                      450

                      1021
                      Recoveries of prior year unpaid obligations
                      9

                      1050
                      Unobligated balance (total)
                      1,191
                      1,090
                      1,143

                      Budget authority:

                      Appropriations, discretionary:

                      1131
                      Unobligated balance of appropriations permanently reduced
                      –100

                      1930
                      Total budgetary resources available
                      1,091
                      1,090
                      1,143

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      565
                      693
                      968

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      535
                      668
                      661

                      3010
                      New obligations, unexpired accounts
                      526
                      397
                      175

                      3020
                      Outlays (gross)
                      –384
                      –404
                      –307

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –9

                      3050
                      Unpaid obligations, end of year
                      668
                      661
                      529

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      535
                      668
                      661

                      3200
                      Obligated balance, end of year
                      668
                      661
                      529

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      –100

                      Outlays, gross:

                      4011
                      Outlays from discretionary balances
                      384
                      404
                      307

                      4180
                      Budget authority, net (total)
                      –100

                      4190
                      Outlays, net (total)
                      384
                      404
                      307

             The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
                accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
                technology infrastructure.

          Object Classification (in millions of dollars)

                      Identification code 075–0125–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      23.1
                      Rental payments to GSA
                      2
                      2
                      1

                      25.1
                      Advisory and assistance services
                      33
                      23
                      10

                      25.2
                      Other services from non-Federal sources
                      161
                      122
                      54

                      25.3
                      Other goods and services from Federal sources
                      26
                      20
                      9

                      25.4
                      Operation and maintenance of facilities
                      206
                      156
                      71

                      25.5
                      Research and development contracts
                      4
                      3
                      1

                      25.7
                      Operation and maintenance of equipment
                      13
                      10
                      5

                      31.0
                      Equipment
                      60
                      45
                      17

                      32.0
                      Land and structures
                      20
                      15
                      7

                      99.0
                      Direct obligations
                      525
                      396
                      175

                      99.5
                      Adjustment for rounding
                      1
                      1

                      99.9
                      Total new obligations, unexpired accounts
                      526
                      397
                      175

          Employment Summary

                      Identification code 075–0125–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      4
                      4

             Health Insurance Reform Implementation Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0119–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      5
                      6
                      6

                      1021
                      Recoveries of prior year unpaid obligations
                      1

                      1050
                      Unobligated balance (total)
                      6
                      6
                      6

                      1930
                      Total budgetary resources available
                      6
                      6
                      6

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      6
                      6
                      6

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      19
                      17
                      15

                      3020
                      Outlays (gross)
                      –1
                      –2
                      –2

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –1

                      3050
                      Unpaid obligations, end of year
                      17
                      15
                      13

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      19
                      17
                      15

                      3200
                      Obligated balance, end of year
                      17
                      15
                      13

                      Budget authority and outlays, net:

                      Mandatory:

                      Outlays, gross:

                      4101
                      Outlays from mandatory balances
                      1
                      2
                      2

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      1
                      2
                      2

             Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111–152) appropriated $1,000,000,000 to the
                Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
                Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
                of 2010 (P.L. 111–148) and the Health Care and Education Reconciliation Act of 2010.

             Prevention and Public Health Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0116–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1120
                      Appropriations transferred to other acct [075–0142]

                      –25

                      1120
                      Appropriations transferred to other acct [075–0943]

                      –805

                      1120
                      Appropriations transferred to other acct [075–1362]

                      –11

                      1160
                      Appropriation, discretionary (total)

                      –841

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      1,000
                      900
                      800

                      1220
                      Appropriations transferred to other accts [075–0142]
                      –28

                      1220
                      Appropriations transferred to other accts [075–0943]
                      –891

                      –800

                      1220
                      Appropriations transferred to other accts [075–1362]
                      –12

                      1230
                      Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                      –69
                      –59

                      1260
                      Appropriations, mandatory (total)

                      841

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross

                      –841

                      Mandatory:

                      4090
                      Budget authority, gross

                      841

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             The Prevention and Public Health Fund supports prevention and public health activities. In FY 2019, $800 million is available
                to support a range of public health efforts intended to prevent disease and reduce health care costs. The Secretary has authority
                to transfer to accounts within HHS.

             Pregnancy Assistance Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0117–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Pregnancy Assistance Fund (Direct)
                      23
                      23
                      25

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      2

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      25
                      25
                      25

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

                      1260
                      Appropriations, mandatory (total)
                      23
                      25
                      25

                      1930
                      Total budgetary resources available
                      23
                      25
                      27

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      2
                      2

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      28
                      28
                      27

                      3010
                      New obligations, unexpired accounts
                      23
                      23
                      25

                      3020
                      Outlays (gross)
                      –23
                      –24
                      –23

                      3050
                      Unpaid obligations, end of year
                      28
                      27
                      29

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      28
                      28
                      27

                      3200
                      Obligated balance, end of year
                      28
                      27
                      29

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      23
                      25
                      25

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority

                      1

                      4101
                      Outlays from mandatory balances
                      23
                      23
                      23

                      4110
                      Outlays, gross (total)
                      23
                      24
                      23

                      4180
                      Budget authority, net (total)
                      23
                      25
                      25

                      4190
                      Outlays, net (total)
                      23
                      24
                      23

             This appropriation funds competitive grants to States to assist pregnant and parenting teens and women.

          Object Classification (in millions of dollars)

                      Identification code 075–0117–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      25.3
                      Other goods and services from Federal sources
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      22
                      22
                      25

                      99.9
                      Total new obligations, unexpired accounts
                      23
                      23
                      25

          Employment Summary

                      Identification code 075–0117–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      2
                      2
                      2

             Section 241 Evaluation Transactions Account

             Program and Financing (in millions of dollars)

                      Identification code 075–3902–0–1–552
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Section 241 Evaluation Transactions Account (Reimbursable)
                      476
                      473
                      418

                      0809
                      Reimbursable program activities, subtotal
                      476
                      473
                      418

                      0900
                      Total new obligations (object class 25.3)
                      476
                      473
                      418

                      Budgetary resources:

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      58
                      473
                      418

                      1701
                      Change in uncollected payments, Federal sources
                      418

                      1750
                      Spending auth from offsetting collections, disc (total)
                      476
                      473
                      418

                      1930
                      Total budgetary resources available
                      476
                      473
                      418

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      905
                      558
                      28

                      3010
                      New obligations, unexpired accounts
                      476
                      473
                      418

                      3011
                      Obligations ("upward adjustments"), expired accounts
                      200

                      3020
                      Outlays (gross)
                      –823
                      –1,003
                      –418

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –200

                      3050
                      Unpaid obligations, end of year
                      558
                      28
                      28

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –923
                      –555
                      –555

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –418

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      786

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –555
                      –555
                      –555

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –18
                      3
                      –527

                      3200
                      Obligated balance, end of year
                      3
                      –527
                      –527

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      476
                      473
                      418

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      58
                      473
                      418

                      4011
                      Outlays from discretionary balances
                      765
                      530

                      4020
                      Outlays, gross (total)
                      823
                      1,003
                      418

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –844
                      –473
                      –418

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –844
                      –473
                      –418

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –418

                      4052
                      Offsetting collections credited to expired accounts
                      786

                      4060
                      Additional offsets against budget authority only (total)
                      368

                      4080
                      Outlays, net (discretionary)
                      –21
                      530

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –21
                      530

             The Public Health Service (PHS) Act Evaluation Transactions account supports the execution of section 241 of the PHS Act.

             Program Support Center

             Federal Funds
             Retirement pay and medical benefits for commissioned officersFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
                under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
                personnel under chapter 55 of title 10, United States Code, such amounts as may be required during the current fiscal year.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0379–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Retirement payments
                      441
                      455
                      469

                      0002
                      Survivors' benefits
                      30
                      31
                      32

                      0003
                      Medical care
                      122
                      121
                      128

                      0900
                      Total new obligations, unexpired accounts
                      593
                      607
                      629

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1

                      12

                      Budget authority:

                      Appropriations, mandatory:

                      1200
                      Appropriation
                      593
                      619
                      629

                      1930
                      Total budgetary resources available
                      593
                      619
                      641

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year

                      12
                      12

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      64
                      62
                      20

                      3010
                      New obligations, unexpired accounts
                      593
                      607
                      629

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

                      3020
                      Outlays (gross)
                      –570
                      –649
                      –629

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –37

                      3050
                      Unpaid obligations, end of year
                      62
                      20
                      20

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      64
                      62
                      20

                      3200
                      Obligated balance, end of year
                      62
                      20
                      20

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      593
                      619
                      629

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      553
                      588
                      598

                      4101
                      Outlays from mandatory balances
                      17
                      61
                      31

                      4110
                      Outlays, gross (total)
                      570
                      649
                      629

                      4180
                      Budget authority, net (total)
                      593
                      619
                      629

                      4190
                      Outlays, net (total)
                      570
                      649
                      629

             The number of beneficiaries using the Commissioned Corps system is estimated as follows:
             Retirement Pay, Survivor Benefits, and Medical Benefits

                         2017
                         2018
                         2019

                         Active Duty:

                         HHS
                         4821
                         4767
                         4748

                         DOJ, BOP
                         832
                         853
                         853

                         Homeland Security
                         488
                         646
                         740

                         EPA
                         55
                         56
                         56

                         All Other
                         283
                         289
                         308

                         Total Active Duty
                         6479
                         6611
                         6705

                         Retirees & Survivors:

                         Retirees
                         6162
                         6200
                         6150

                         Retiree family members and survivors
                         1127
                         1135
                         1125

                         Total Retirement Pay
                         7289
                         7335
                         7275

                         Total Beneficiaries (active duty, retirees, survivors)
                         13768
                         14059
                         14101

             This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
                medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned
                Corps.

          Object Classification (in millions of dollars)

                      Identification code 075–0379–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      13.0
                      Benefits for former personnel
                      471
                      486
                      501

                      25.6
                      Medical care
                      122
                      121
                      128

                      99.9
                      Total new obligations, unexpired accounts
                      593
                      607
                      629

             HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–0170–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Medicare eligible accruals
                      28
                      33
                      30

                      0900
                      Total new obligations (object class 12.2)
                      28
                      33
                      30

                      Budgetary resources:

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      28
                      33
                      30

                      1930
                      Total budgetary resources available
                      28
                      33
                      30

                      Change in obligated balance:

                      Unpaid obligations:

                      3010
                      New obligations, unexpired accounts
                      28
                      33
                      30

                      3020
                      Outlays (gross)
                      –28
                      –33
                      –30

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      28
                      33
                      30

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      28
                      33
                      30

                      4180
                      Budget authority, net (total)
                      28
                      33
                      30

                      4190
                      Outlays, net (total)
                      28
                      33
                      30

             The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
                Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
                appropriation of the annual accrual payment into this fund (P.L. No. 108–375, section 725).

             Health Activities Funds

             Program and Financing (in millions of dollars)

                      Identification code 075–9913–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      1
                      1
                      1

                      1930
                      Total budgetary resources available
                      1
                      1
                      1

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      1
                      1
                      1

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)

             HHS Service and Supply Fund

             Program and Financing (in millions of dollars)

                      Identification code 075–9941–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0801
                      Program Support Center
                      1,176
                      1,395
                      1,333

                      0802
                      OS activities
                      441
                      454
                      470

                      0900
                      Total new obligations, unexpired accounts
                      1,617
                      1,849
                      1,803

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      181
                      201
                      295

                      1021
                      Recoveries of prior year unpaid obligations
                      76
                      181
                      181

                      1050
                      Unobligated balance (total)
                      257
                      382
                      476

                      Budget authority:

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      1,485
                      1,762
                      1,508

                      1701
                      Change in uncollected payments, Federal sources
                      76

                      1750
                      Spending auth from offsetting collections, disc (total)
                      1,561
                      1,762
                      1,508

                      1930
                      Total budgetary resources available
                      1,818
                      2,144
                      1,984

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      201
                      295
                      181

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      909
                      1,011
                      300

                      3010
                      New obligations, unexpired accounts
                      1,617
                      1,849
                      1,803

                      3020
                      Outlays (gross)
                      –1,439
                      –2,379
                      –1,508

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –76
                      –181
                      –181

                      3050
                      Unpaid obligations, end of year
                      1,011
                      300
                      414

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –460
                      –536
                      –536

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      –76

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –536
                      –536
                      –536

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      449
                      475
                      –236

                      3200
                      Obligated balance, end of year
                      475
                      –236
                      –122

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      1,561
                      1,762
                      1,508

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      857
                      1,762
                      1,508

                      4011
                      Outlays from discretionary balances
                      582
                      617

                      4020
                      Outlays, gross (total)
                      1,439
                      2,379
                      1,508

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –1,178
                      –1,762
                      –1,508

                      4033
                      Non-Federal sources
                      –307

                      4040
                      Offsets against gross budget authority  and outlays (total)
                      –1,485
                      –1,762
                      –1,508

                      Additional offsets against gross budget authority only:

                      4050
                      Change in uncollected pymts, Fed sources, unexpired
                      –76

                      4080
                      Outlays, net (discretionary)
                      –46
                      617

                      4180
                      Budget authority, net (total)

                      4190
                      Outlays, net (total)
                      –46
                      617

             The HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department
                and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support, information
                technology, financial management operations, and administrative services, including acquisitions management, building and
                property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational
                Health Service. The Office of the Secretary activities include the Service and Supply Fund Manager's Office, departmental
                contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
                small business consolidation, grants tracking, the physical security component of the Department's implementation of Homeland
                Security Presidential Directive 12, and commercial services management.

             Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the
                agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section
                in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either
                through an allocation account or by directly citing that agency's appropriation.

          Object Classification (in millions of dollars)

                      Identification code 075–9941–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Reimbursable obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      93
                      104
                      105

                      11.3
                      Other than full-time permanent
                      4
                      5
                      4

                      11.5
                      Other personnel compensation
                      3
                      3
                      3

                      11.7
                      Military personnel
                      6
                      7
                      7

                      11.8
                      Special personal services payments
                      9
                      8
                      9

                      11.9
                      Total personnel compensation
                      115
                      127
                      128

                      12.1
                      Civilian personnel benefits
                      31
                      33
                      34

                      12.2
                      Military personnel benefits
                      3
                      2
                      2

                      21.0
                      Travel and transportation of persons
                      2
                      4
                      2

                      22.0
                      Transportation of things
                      2
                      5
                      5

                      23.1
                      Rental payments to GSA
                      19
                      20
                      21

                      23.3
                      Communications, utilities, and miscellaneous charges
                      8
                      12
                      12

                      24.0
                      Printing and reproduction
                      5
                      6
                      6

                      25.1
                      Advisory and assistance services
                      122
                      165
                      172

                      25.2
                      Other services from non-Federal sources
                      1,102
                      1,165
                      1,147

                      25.3
                      Other goods and services from Federal sources
                      87
                      109
                      90

                      25.4
                      Operation and maintenance of facilities
                      10
                      20
                      14

                      25.6
                      Medical care
                      23
                      35
                      36

                      25.7
                      Operation and maintenance of equipment
                      45
                      66
                      66

                      26.0
                      Supplies and materials
                      39
                      75
                      63

                      31.0
                      Equipment
                      4
                      5
                      5

                      99.9
                      Total new obligations, unexpired accounts
                      1,617
                      1,849
                      1,803

          Employment Summary

                      Identification code 075–9941–0–4–551
                      2017 actual
                      2018 est.
                      2019 est.

                      2001
                      Reimbursable civilian full-time equivalent employment
                      930
                      930
                      930

                      2101
                      Reimbursable military average strength employment
                      71
                      71
                      71

                      3101
                      Allocation account military average strength employment
                      1,603
                      1,788
                      1,901

          Trust Funds
             Miscellaneous Trust Funds

             Special and Trust Fund Receipts (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      0100
                      Balance, start of year

                      5

                      Receipts:

                      Current law:

                      1130
                      Contributions, Indian Health Facilities
                      14
                      48
                      48

                      1130
                      Contributions, N.I.H., Unconditional Gift Fund
                      6
                      3
                      3

                      1130
                      Centers for Disease Control, Gifts and Donations
                      20
                      15
                      15

                      1130
                      Contributions, N.I.H., Conditional Gift Fund
                      47
                      27
                      27

                      1130
                      Contributions to the Indian Health Service Gift Fund

                      1
                      1

                      1140
                      Interest, Miscellaneous Trust Funds
                      1
                      1
                      1

                      1199
                      Total current law receipts
                      88
                      95
                      95

                      1999
                      Total receipts
                      88
                      95
                      95

                      2000
                      Total: Balances and receipts
                      88
                      95
                      100

                      Appropriations:

                      Current law:

                      2101
                      Miscellaneous Trust Funds
                      –88
                      –90
                      –84

                      5099
                      Balance, end of year

                      5
                      16

          Program and Financing (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0002
                      Gifts
                      79
                      110
                      110

                      0003
                      Contributions, Indian Health Facilities
                      13
                      9
                      9

                      0900
                      Total new obligations, unexpired accounts
                      92
                      119
                      119

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      198
                      199
                      239

                      1021
                      Recoveries of prior year unpaid obligations
                      5
                      8
                      8

                      1033
                      Recoveries of prior year paid obligations

                      61
                      61

                      1050
                      Unobligated balance (total)
                      203
                      268
                      308

                      Budget authority:

                      Appropriations, mandatory:

                      1201
                      Appropriation (special or trust fund)
                      88
                      90
                      84

                      1930
                      Total budgetary resources available
                      291
                      358
                      392

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      199
                      239
                      273

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      61
                      72
                      41

                      3010
                      New obligations, unexpired accounts
                      92
                      119
                      119

                      3020
                      Outlays (gross)
                      –76
                      –142
                      –142

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –5
                      –8
                      –8

                      3050
                      Unpaid obligations, end of year
                      72
                      41
                      10

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      61
                      72
                      41

                      3200
                      Obligated balance, end of year
                      72
                      41
                      10

                      Budget authority and outlays, net:

                      Mandatory:

                      4090
                      Budget authority, gross
                      88
                      90
                      84

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      20
                      9
                      8

                      4101
                      Outlays from mandatory balances
                      56
                      133
                      134

                      4110
                      Outlays, gross (total)
                      76
                      142
                      142

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources

                      –61
                      –61

                      Additional offsets against gross budget authority only:

                      4143
                      Recoveries of prior year paid obligations, unexpired accounts

                      61
                      61

                      4160
                      Budget authority, net (mandatory)
                      88
                      90
                      84

                      4170
                      Outlays, net (mandatory)
                      76
                      81
                      81

                      4180
                      Budget authority, net (total)
                      88
                      90
                      84

                      4190
                      Outlays, net (total)
                      76
                      81
                      81

                      Memorandum (non-add) entries:

                      5000
                      Total investments, SOY: Federal securities: Par value
                      21
                      34
                      34

                      5001
                      Total investments, EOY: Federal securities: Par value
                      34
                      34
                      34

             Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction,
                improvement, extension, and provision of sanitation facilities.

          Object Classification (in millions of dollars)

                      Identification code 075–9971–0–7–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      3
                      3
                      3

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      4
                      4
                      4

                      12.1
                      Civilian personnel benefits
                      1
                      1
                      1

                      21.0
                      Travel and transportation of persons
                      2
                      2
                      2

                      25.1
                      Advisory and assistance services
                      4
                      6
                      6

                      25.2
                      Other services from non-Federal sources
                      17
                      25
                      25

                      25.3
                      Other goods and services from Federal sources
                      7
                      7
                      7

                      25.5
                      Research and development contracts
                      5
                      5
                      5

                      25.6
                      Medical care
                      3
                      3
                      3

                      26.0
                      Supplies and materials
                      7
                      7
                      7

                      31.0
                      Equipment
                      1
                      1
                      1

                      41.0
                      Grants, subsidies, and contributions
                      41
                      58
                      58

                      99.9
                      Total new obligations, unexpired accounts
                      92
                      119
                      119

          Employment Summary

                      Identification code 075–9971–0–7–551
                      2017 actual
                      2018 est.
                      2019 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, $80,000,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary and investigating
                non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228.
          Note.—A full-year 2018 appropriation for this account was not enacted at the time the budget was prepared; therefore, the
             budget assumes this account is operating under the Continuing Appropriations Act, 2018 (Division D of P.L. 115–56, as amended).
             The amounts included for 2018 reflect the annualized level provided by the continuing resolution.

          Program and Financing (in millions of dollars)

                      Identification code 075–0128–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Obligations by program activity:

                      0001
                      Office of Inspector General (Direct)
                      81
                      81
                      80

                      0801
                      Office of Inspector General HCFAC Trust Fund
                      206
                      217
                      232

                      0802
                      Office of Inspector General (Direct Reimbursable)
                      16
                      21
                      21

                      0803
                      Office of Inspector General HCFAC Discretionary
                      86
                      88
                      87

                      0899
                      Total reimbursable obligations
                      308
                      326
                      340

                      0900
                      Total new obligations, unexpired accounts
                      389
                      407
                      420

                      Budgetary resources:

                      Unobligated balance:

                      1000
                      Unobligated balance brought forward, Oct 1
                      34
                      41
                      20

                      1001
                      Discretionary unobligated balance brought fwd, Oct 1
                      1
                      7

                      1011
                      Unobligated balance transfer from other acct [075–0140]
                      1

                      1021
                      Recoveries of prior year unpaid obligations
                      13

                      1050
                      Unobligated balance (total)
                      48
                      41
                      20

                      Budget authority:

                      Appropriations, discretionary:

                      1100
                      Appropriation
                      80
                      80
                      80

                      1121
                      Appropriations transferred from other acct [075–9911]
                      2
                      1

                      1160
                      Appropriation, discretionary (total)
                      82
                      81
                      80

                      Spending authority from offsetting collections, discretionary:

                      1700
                      Collected
                      96
                      103
                      109

                      1701
                      Change in uncollected payments, Federal sources
                      2

                      1750
                      Spending auth from offsetting collections, disc (total)
                      98
                      103
                      109

                      Spending authority from offsetting collections, mandatory:

                      1800
                      Collected
                      209
                      202
                      220

                      1801
                      Change in uncollected payments, Federal sources
                      –7

                      1802
                      Offsetting collections (previously unavailable)
                      1

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

                      1850
                      Spending auth from offsetting collections, mand (total)
                      202
                      202
                      220

                      1900
                      Budget authority (total)
                      382
                      386
                      409

                      1930
                      Total budgetary resources available
                      430
                      427
                      429

                      Memorandum (non-add) entries:

                      1941
                      Unexpired unobligated balance, end of year
                      41
                      20
                      9

                      Change in obligated balance:

                      Unpaid obligations:

                      3000
                      Unpaid obligations, brought forward, Oct 1
                      67
                      78
                      104

                      3010
                      New obligations, unexpired accounts
                      389
                      407
                      420

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

                      3020
                      Outlays (gross)
                      –363
                      –381
                      –413

                      3040
                      Recoveries of prior year unpaid obligations, unexpired
                      –13

                      3041
                      Recoveries of prior year unpaid obligations, expired
                      –3

                      3050
                      Unpaid obligations, end of year
                      78
                      104
                      111

                      Uncollected payments:

                      3060
                      Uncollected pymts, Fed sources, brought forward, Oct 1
                      –130
                      –114
                      –114

                      3070
                      Change in uncollected pymts, Fed sources, unexpired
                      5

                      3071
                      Change in uncollected pymts, Fed sources, expired
                      11

                      3090
                      Uncollected pymts, Fed sources, end of year
                      –114
                      –114
                      –114

                      Memorandum (non-add) entries:

                      3100
                      Obligated balance, start of year
                      –63
                      –36
                      –10

                      3200
                      Obligated balance, end of year
                      –36
                      –10
                      –3

                      Budget authority and outlays, net:

                      Discretionary:

                      4000
                      Budget authority, gross
                      180
                      184
                      189

                      Outlays, gross:

                      4010
                      Outlays from new discretionary authority
                      151
                      168
                      172

                      4011
                      Outlays from discretionary balances
                      22
                      19
                      17

                      4020
                      Outlays, gross (total)
                      173
                      187
                      189

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4030
                      Federal sources
                      –107
                      –103
                      –109

                      Additional offsets against gross budget authority only:

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

                      4052
                      Offsetting collections credited to expired accounts
                      11

                      4060
                      Additional offsets against budget authority only (total)
                      9

                      4070
                      Budget authority, net (discretionary)
                      82
                      81
                      80

                      4080
                      Outlays, net (discretionary)
                      66
                      84
                      80

                      Mandatory:

                      4090
                      Budget authority, gross
                      202
                      202
                      220

                      Outlays, gross:

                      4100
                      Outlays from new mandatory authority
                      136
                      184
                      200

                      4101
                      Outlays from mandatory balances
                      54
                      10
                      24

                      4110
                      Outlays, gross (total)
                      190
                      194
                      224

                      Offsets against gross budget authority and outlays:

                      Offsetting collections (collected) from:

                      4120
                      Federal sources
                      –199
                      –191
                      –208

                      4123
                      Non-Federal sources
                      –10
                      –11
                      –12

                      4130
                      Offsets against gross budget authority and outlays (total)
                      –209
                      –202
                      –220

                      Additional offsets against gross budget authority only:

                      4140
                      Change in uncollected pymts, Fed sources, unexpired
                      7

                      4170
                      Outlays, net (mandatory)
                      –19
                      –8
                      4

                      4180
                      Budget authority, net (total)
                      82
                      81
                      80

                      4190
                      Outlays, net (total)
                      47
                      76
                      84

                      Memorandum (non-add) entries:

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

                      5092
                      Unexpired unavailable balance, EOY: Offsetting collections
                      1
                      1
                      1

             The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
                Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
                1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
                and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
                HHS programs well serve the people that use them. OIG fulfills its mission through a broad range of audits, evaluations, investigations,
                and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health
                Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996.

          Object Classification (in millions of dollars)

                      Identification code 075–0128–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      Direct obligations:

                      Personnel compensation:

                      11.1
                      Full-time permanent
                      40
                      40
                      40

                      11.3
                      Other than full-time permanent
                      1
                      1
                      1

                      11.5
                      Other personnel compensation
                      1
                      1
                      1

                      11.9
                      Total personnel compensation
                      42
                      42
                      42

                      12.1
                      Civilian personnel benefits
                      16
                      16
                      16

                      21.0
                      Travel and transportation of persons
                      2
                      1
                      2

                      22.0
                      Transportation of things
                      1
                      1
                      1

                      23.1
                      Rental payments to GSA
                      4
                      5
                      5

                      23.3
                      Communications, utilities, and miscellaneous charges
                      1
                      1
                      1

                      25.2
                      Other services from non-Federal sources
                      1
                      1
                      2

                      25.3
                      Other goods and services from Federal sources
                      8
                      8
                      7

                      25.4
                      Operation and maintenance of facilities
                      1
                      1
                      1

                      31.0
                      Equipment
                      5
                      5
                      5

                      99.0
                      Direct obligations
                      81
                      81
                      82

                      99.0
                      Reimbursable obligations
                      308
                      326
                      338

                      99.9
                      Total new obligations, unexpired accounts
                      389
                      407
                      420

          Employment Summary

                      Identification code 075–0128–0–1–551
                      2017 actual
                      2018 est.
                      2019 est.

                      1001
                      Direct civilian full-time equivalent employment
                      355
                      347
                      347

                      2001
                      Reimbursable civilian full-time equivalent employment
                      1,253
                      1,285
                      1,303

             General and Administrative Provisions

             GENERAL FUND RECEIPT ACCOUNTS

             (in millions of dollars)

                      2017 actual
                      2018 est.
                      2019 est.

                      Offsetting receipts from the public:

                      075–143500
                      General Fund Proprietary Interest Receipts, not Otherwise Classified
                      106
                      90
                      90

                      075–267403
                      Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                      127
                      15

                      075–275830
                      Downward Reestimates of Subsidies, Health Centers
                      1

                      075–310700
                      Federal Share of Child Support Collections
                      633
                      621
                      608

                      075–310700
                      Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO

                      11

                      075–322000
                      All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                      57
                      34
                      34

                      General Fund Offsetting receipts from the public
                      924
                      760
                      743

                      Intragovernmental payments:

                      075–388500
                      Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                      87

                      General Fund Intragovernmental payments
                      87

             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 2019 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 2019:
          (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
             Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
             that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
             of 1980 and other applicable statutes administered by the Department of State.

          (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
             to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
             for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
             functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
             and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
             through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
             foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
             of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
             chronic and environmental diseases, and other health activities abroad.

          (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
             benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
             4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
             comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
             percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
             official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
             the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
             Service Act of 1980, to individuals serving in the Foreign Service.
          '

          (transfer of funds)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
          and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
          virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
          of any transfer.'

          (transfer of funds)SEC. 212. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
          jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
          "Office of AIDS Research" account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
          to carry out section 2353(d)(3) of the PHS Act.SEC. 213. (a) Authority.—Notwithstanding any other provision of law, the Director of NIH ("Director") may use funds available under section 402(b)(7)
          or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
          out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
          in such section 402(b)(12).
          (b) Peer review.—In entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
             with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
             technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
             that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
             Act.
          SEC. 214. Not to exceed $45,000,000 of funds appropriated by this Act to the institutes and centers of the National Institutes of Health
          may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the
          activities authorized herein, at not to exceed $3,500,000 per project.'

          (transfer of funds)SEC. 215. (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
          than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
          319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), if—
          (1) funds are available and obligated—
             (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
             (B) for the estimated costs associated with a necessary termination of the contract; and

          (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
             full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.

          (b) A contract entered into under this section—
             (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
             (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
          SEC. 216. Section 229 of division H of Public Law 114–113 shall continue in effect through January 1, 2020.SEC. 217. (a) In general.—Under the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within the Department
          may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit within the
          Department or of another agency under which—
          (1) the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
             or cooperative agreement on behalf of the ordering agency or unit;

          (2) the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
             and

          (3) the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
             and for the service of executing or managing the grant or cooperative agreement.

          (b) Conditions.—The conditions for making an agreement described in subsection (a) are that —
             (1) amounts are available;
             (2) the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
             (3) the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.

          (c) Payment.—Payment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the agency
             or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for any
             part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a request
             for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance shall
             be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
             and the actual cost of the service provided.

          (d) Limitations on funds.—A condition or limitation applicable to amounts for grant or cooperative agreements of the ordering agency or unit applies
             to an agreement made under this section and to a grant or cooperative agreement made under such agreement.

          (e) Obligation of appropriations.—An agreement made under this section obligates an appropriation of the ordering agency or unit. The amount obligated is
             deobligated to the extent that the agency or unit providing the service has not incurred obligations, before the end of the
             period of availability of the appropriation, in —
             (1) awarding the grant or cooperative agreement; or
             (2) providing the agreed-on services.

          (f) No effect on other laws.—This section does not affect other laws about reimbursable agreements.SEC. 218. 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. 219. Funds appropriated in this Act to accounts that received appropriations in the Department of Health and Human Services Appropriations
          Act, 2017, 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. 220. Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)), the Secretary shall charge health care facilities or entities fees 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 in addition to any other funds available for conducting 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 for such purpose. No such fees shall be charged to an Indian Health Program (as that term is defined in section 4 of the Indian Health Care
             Improvement Act).SEC. 221.   Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended— (a)  in subsection (a)(5)(C)— (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE.—A covered entity shall
                      permit"
             (2)  by inserting at the end the following:

                "(ii) USE OF SAVINGS.—A covered entity shall permit the Secretary to audit at the Secretary's expense the records of the entity
                         to determine how net income from purchases under this section are used by the covered entity.

                "(iii) RECORDS RETENTION.— Covered entities shall retain such records and provide such records and reports as deemed necessary
                         by the Secretary for carrying out this subparagraph.".

          (b)  by adding at the end the following new subsection: "(f) REGULATIONS.—The Secretary may promulgate such regulations as the
                   Secretary determines necessary or appropriate to carry out the provisions of this section.". SEC. 222. (a)  IN GENERAL.—A State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
                of Health and Human Services—Administration for Community Living—Aging and Disability Services Programs" to carry out programs
                under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
                the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
                or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
                limitations on such transfers under the OAA or such heading. (b)  NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.—A State or tribal organization which elects to make a transfer under
                   subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
                   of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
                   the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
                   the Secretary determines that such transfer is not consistent with the objectives of the OAA.
          (c)  RULES OF CONSTRUCTION.—No transfer of grant funds by a State or tribal organization under this section shall be construed— (1)  as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
                      by the Secretary; or
             (2)  to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
                      funds.
          SEC. 223.   Funds available to the Secretary under this or any prior Act that are available for acquisition of real property or for construction
                or improvement of facilities shall also be available to make transportation and infrastructure related improvements on property
                located directly adjacent to property owned by the Federal Government, provided that the primary benefit of such improvements
                accrues to HHS or the component thereof funding the improvements. SEC. 224.   With respect to an individual who is serving as principal investigator on one or more grants or cooperative agreements funded
                by the National Institutes of Health (NIH) under this title, none of the funds made available to NIH by this title shall be
                used, together with any funds from the analogous title in any previous appropriations act, to pay the salary of such individual
                at a rate exceeding 90 percent of such salary. SEC. 225.   Funds appropriated in this or any prior Act or the Patient Protection and Affordable Care Act that are available for salaries
                and expenses of employees of the Department of Health and Human Services shall also be available for the primary and secondary
                schooling of eligible dependents of HHS personnel stationed in the Commonwealth of Puerto Rico, the Commonwealth of the Northern
                Mariana Islands, and the possessions of the United States at costs not in excess of those paid for or reimbursed by the Department
                of Defense.  SEC. 226.  Funds appropriated in this or any prior Act or the Patient Protection and Affordable Care Act that are available for salaries
                and expenses of employees of the Department of Health and Human Services shall also be available to pay travel and related
                expenses of such an employee or of a member of his or her family, when such employee is assigned to duty, in the United States
                or in a U.S. territory, during a period and in a location that are the subject of a determination of a public health emergency
                under section 319 of the Public Health Service Act and such travel is necessary to obtain medical care for an illness, injury,
                or medical condition that cannot be adequately addressed in that location at that time. For purposes of this section, the
                term "U.S. territory" means Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American
                Samoa, or the Trust Territory of the Pacific Islands. SEC. 227.  Notwithstanding section 12(b) of the Federal Advisory Committee Act, funds made available by this Act for the "National Institutes
                of Health—Office of the Director" account shall also be available to establish and operate the Research Policy Board authorized
                by section 2034(f) of Public Law 114–255.