Appendix - Department of Health and Human Services

For 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.

For 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.


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


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.


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


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

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.


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.


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


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


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)


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.

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.


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


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.


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


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

1001	Direct civilian full-time equivalent employment	26


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.


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


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

2001	Reimbursable civilian full-time equivalent employment	40	37	37

Federal Funds

For 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:".

For 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.

For 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.

For 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.

For 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.

For 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.

For 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.

For 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".


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


		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.


Program	Account Balance


HPSL	416,265,386
NSL	188,621,972
PCL	239,076,684
LDS	157,612,046

Total	1,001,576,088


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


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


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.


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


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


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.


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).


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


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


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


		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.


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


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


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.


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


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


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


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.


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


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.


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

For 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.


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


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.


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


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

Federal Funds

For 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.


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


		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.


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


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


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.


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

For 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.


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.

For 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.


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


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.


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


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

Appropriations 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.

Federal Funds

For 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.

For 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.

For 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.

For 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.

For 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.

For 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.

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

For carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $266,309,000.

For 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.

For 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.

For 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.


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


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.


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


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

For acquisition of real property, equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2023.


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


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


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.


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


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

For 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.


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


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


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


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.


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


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

Federal Funds

For 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.

For 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.

For carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $297,050,000.

For carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,305,132,000.

For carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,294,472,000.

For carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $3,423,408,000.

For 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.

For carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $963,045,000.

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

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

For 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.

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

For carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases, $393,311,000.

For carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $304,812,000.

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

For carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $337,247,000

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

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

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

For carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $249,138,000.

For carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $93,974,000.

For carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research, $201,686,000.

For 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.

For 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").

For 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.

For 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.

For 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.

For 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.

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.

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.

For carrying out title II (and section 14 with respect to such title) of the Rehabilitation Act of 1973, $95,127,000.


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


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


		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.


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


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


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.


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.

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.


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


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.


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


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)

Federal Funds

For 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).

For 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.

For 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.

For 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.


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.


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


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

Federal Funds


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.


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


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

Federal Funds

For 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.


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:

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Food and Drug Administration

Federal Funds

Salaries and expenses

Buildings and facilities

Salaries and Expenses

(Legislative proposal, not subject to PAYGO)

FDA Working Capital Fund

Payment to the FDA Innovation Account, CURES Act

FDA Innovation, CURES Act

Revolving Fund for Certification and Other Services

Health Resources and Services Administration

Federal Funds

Primary health care

Health workforce

maternal and child health

Ryan white HIV/AIDS program

health care systems

Rural health

Family Planning

program management

Health Resources and Services

(Legislative proposal, subject to PAYGO)

Vaccine Injury Compensation

Covered Countermeasure Process Fund

Maternal, Infant, and Early Childhood Home Visiting Programs

Maternal, Infant, and Early Childhood Home Visiting Programs

(Legislative proposal, subject to PAYGO)

Health Center Guaranteed Loan Financing Account

Medical Facilities Guarantee and Loan Fund

Trust Funds

Vaccine injury compensation program trust fund

Indian Health Service

Federal Funds

Indian health services

Indian Health Services

(Legislative proposal, subject to PAYGO)

Contract support costs

Indian health facilities

ADMINISTRATIVE PROVISIONS—INDIAN HEALTH SERVICE

Administrative provisions—indian health service

Centers for Disease Control and Prevention

Federal Funds

Immunization and respiratory diseases

HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis prevention

Emerging and zoonotic infectious diseases

Chronic disease prevention and health promotion

Birth defects, developmental disabilities, disabilities and health

Public Health Scientific Services

Environmental health

Injury prevention and control

National Institute for Occupational Safety and Health

Energy employees occupational illness compensation program

Global health

public health preparedness and response

cdc-wide activities and program support

buildings and facilities

CDC Working Capital Fund

Toxic substances and environmental public health

World Trade Center Health Program Fund

National Institutes of Health

Federal Funds

national cancer institute

national heart, lung, and blood institute

national institute of dental and craniofacial research

national institute of diabetes and digestive and kidney diseases

national institute of neurological disorders and stroke

national institute of allergy and infectious diseases

national institute of general medical sciences

eunice kennedy shriver national institute of child health and human development

national eye institute

national institute of environmental health sciences

National institute of environmental health sciences

national institute on aging

national institute of arthritis and musculoskeletal and skin diseases

national institute on deafness and other communication disorders

national institute of nursing research

national institute on alcohol abuse and alcoholism

national institute on drug abuse

national institute of mental health