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



   
      
      
         DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
            
         
      
      
   
   
      DEPARTMENT OF HEALTH AND HUMAN SERVICES                                                                                  
         
      
         Food and Drug Administration                                                                                             
            
         Federal Funds
         Salaries and expensesFor necessary expenses of the Food and Drug Administration, including hire and purchase of passenger motor vehicles; for payment
            of space rental and related costs pursuant to Public Law 92â313 for programs and activities of the Food and Drug Administration
            which are included in this Act; for rental of special purpose space in the District of Columbia or elsewhere; for miscellaneous
            and emergency expenses of enforcement activities, authorized and approved by the Secretary and to be accounted for solely
            on the Secretary's certificate, not to exceed $25,000; and notwithstanding section 521 of Public Law 107â188; $5,083,474,000: Provided, That of the amount provided under this heading, $960,568,000 shall be derived from prescription drug user fees authorized by 21 U.S.C. 379h, and shall be credited to this
               account and remain available until expended; $196,668,000 shall be derived from medical device user fees authorized by 21
               U.S.C. 379j, and shall be credited to this account and remain available until expended; $501,396,000 shall be derived from
               human generic drug user fees authorized by 21 U.S.C. 379j-42, and shall be credited to this account and remain available until
               expended; $40,922,000 shall be derived from biosimilar biological product user fees authorized by 21 U.S.C. 379j-52, and shall
               be credited to this account and remain available until expended; $712,000,000 shall be derived from tobacco product user fees authorized by 21 U.S.C. 387s, and shall be credited to this account and remain
            available until expended: Provided further, That in addition to and notwithstanding any other provision under this heading, amounts collected for prescription drug user fees, medical device user fees, human generic drug user fees, and biosimilar
               biological product user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited
               to this account and remain available until expended: Provided further, That fees derived from prescription drug, medical device,
               human generic drug, and biosimilar biological product assessments for fiscal year 2019, including any such fees collected prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified under this heading and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 shall not be included in amounts under this heading: Provided further, That none of these funds shall be used to develop, establish, or operate any program of user fees authorized by 31 U.S.C.
            9701: Provided further, That not to exceed $25,000 of this amount shall be for official reception and representation expenses, not otherwise provided
            for, as determined by the Commissioner:  Provided further, That funds may be transferred from one specified activity to another with the prior notification of the Committees on Appropriations
            of both Houses of Congress.
      In addition, mammography user fees authorized by 42 U.S.C. 263b, export certification user fees authorized by 21 U.S.C. 381,
            priority review user fees authorized by 21 U.S.C. 360n and 360ff, food and feed recall fees, food reinspection fees, and voluntary
            qualified importer program fees authorized by 21 U.S.C. 379j-31, outsourcing facility fees authorized by 21 U.S.C. 379j-62,
            prescription drug wholesale distributor licensing and inspection fees authorized by 21 U.S.C. 353(e)(3), third-party logistics
            provider licensing and inspection fees authorized by 21 U.S.C. 360eee-3(c)(1), third-party auditor fees authorized by 21 U.S.C.
            384d(c)(8), and Medical Countermeasure Priority Review Voucher User Fees authorized by 21 U.S.C. 360bbb-4a, shall be credited
            to this account, to remain available until expended.
      
         Buildings and facilitiesFor plans, construction, repair, improvement, extension, alteration, demolition, and purchase of fixed equipment or facilities
            of or used by the Food and Drug Administration, where not otherwise provided, $11,788,000, to remain available until expended.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â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
                  â2
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  1
                  2
                  3
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  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 [075â0128]
                  â2
                  â1
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â4613]
                  
                  
                  â5
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â35
                  
               
               
                  1702
                  Offsetting collections (previously unavailable)
                  611
                  
                  
               
               
                  1723
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  
                  â16
                  
               
               
                  1725
                  Spending authority from offsetting collections precluded from obligation (limitation on obligations)
                  â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)
                  â4,989
                  â4,968
                  â5,242
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â57
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â114
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  2,723
                  2,874
                  2,843
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â71
                  â65
                  â30
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â35
                  35
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  41
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â65
                  â30
                  â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:
                  â31
                  â35
                  
               
               
                  4033
                  Non-Federal sources:
                  â1,645
                  â2,345
                  â2,464
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,676
                  â2,380
                  â2,464
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â35
                  35
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â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:
                  â4
                  
                  
               
               
                  4123
                  Non-Federal sources:
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â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)
                  â3
                  4
                  4
               
               
                  4180
                  Budget authority, net (total)
                  3,195
                  2,766
                  2,751
               
               
                  4190
                  Outlays, net (total)
                  3,308
                  2,588
                  2,778
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  643
                  229
                  245
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  229
                  245
                  245
               
               
                  
                     
                  
               
            
         
      
      
         The Food and Drug Administration (FDA) promotes and protects public health by overseeing the safety, efficacy, quality, and
            security of human and veterinary drugs, biological products, medical devices, foods, cosmetics, and products that emit radiation.
            FDA also has responsibility for regulating the manufacturing, marketing, and distribution of tobacco products to protect public
            health and to reduce tobacco use by minors. FDA advances public health by helping to speed innovations that make medicines
            more effective, safe, and affordable and by helping the public get the accurate, science-based information they need to use
            medicines and foods to maintain and improve their health. FDA supports the Nation's counterterrorism capability by ensuring
            the security of the food supply and by fostering the development of medical products and countermeasures to respond to deliberate
            and naturally emerging public health threats. The FY 2019 Budget includes $5.3 billion in total resources for FDA. The Budget
            prioritizes resources across core public health activities to support food and medical product safety, including implementation
            of the 21st Century Cures Act and the FDA Reauthorization Act of 2017. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  939
                  952
                  926
               
               
                  11.3
                  Other than full-time permanent
                  89
                  90
                  88
               
               
                  11.5
                  Other personnel compensation
                  46
                  47
                  46
               
               
                  11.7
                  Military personnel
                  63
                  64
                  66
               
               
                  11.8
                  Special personal services payments
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,138
                  1,154
                  1,127
               
               
                  12.1
                  Civilian personnel benefits
                  350
                  354
                  345
               
               
                  12.2
                  Military personnel benefits
                  32
                  32
                  33
               
               
                  21.0
                  Travel and transportation of persons
                  49
                  47
                  48
               
               
                  22.0
                  Transportation of things
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  170
                  169
                  168
               
               
                  23.2
                  Rental payments to others
                  3
                  3
                  3
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  22
                  22
                  22
               
               
                  24.0
                  Printing and reproduction
                  2
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  53
                  51
                  52
               
               
                  25.2
                  Other services from non-Federal sources
                  357
                  355
                  356
               
               
                  25.3
                  Other goods and services from Federal sources
                  142
                  137
                  139
               
               
                  25.4
                  Operation and maintenance of facilities
                  85
                  83
                  85
               
               
                  25.5
                  Research and development contracts
                  19
                  19
                  19
               
               
                  25.7
                  Operation and maintenance of equipment
                  100
                  97
                  99
               
               
                  26.0
                  Supplies and materials
                  51
                  49
                  50
               
               
                  31.0
                  Equipment
                  37
                  36
                  36
               
               
                  32.0
                  Land and structures
                  3
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  157
                  156
                  159
               
               
                  42.0
                  Insurance claims and indemnities
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,775
                  2,774
                  2,751
               
               
                  99.0
                  Reimbursable obligations
                  2,358
                  2,345
                  2,460
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,133
                  5,119
                  5,211
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â0â1â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  9,748
                  9,704
                  9,402
               
               
                  1101
                  Direct military average strength employment
                  690
                  690
                  690
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  6,167
                  6,777
                  6,739
               
               
                  2101
                  Reimbursable military average strength employment
                  437
                  437
                  428
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  25
                  25
                  25
               
               
                  3101
                  Allocation account military average strength employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Salaries and Expenses 
         (Legislative proposal, not subject to PAYGO)Contingent upon the enactment of authorizing legislation, the Secretary shall charge a fee for animal drug review, animal generic drug review activities, and over-the-counter monograph drug activities: Provided, That fees of $25,129,000, for animal drug reviews, shall be credited to this account and remain available until expended; $13,076,000 for animal generic drug reviews, shall be credited to this account and remain available until expended; $22,000,000 for over-the-counter monograph drug activities, shall be credited to this account and remain available until expended: Provided further, That, in addition to and notwithstanding any other provision under this heading, amounts collected for animal drug, animal generic drug, and over-the-counter monograph drug user fees that exceed the respective fiscal year 2019 limitations are appropriated and shall be credited to this account and remain available until expended: Provided further, That fees derived from animal drug, animal generic drug, and over-the-counter monograph drug reviews for fiscal year 2019 received during fiscal year 2019, including any such fees assessed prior to fiscal year 2019 but credited for fiscal year 2019, shall be subject to the fiscal year 2019 limitations: Provided further, That the Secretary may accept payment during fiscal year 2019 of user fees specified in this paragraph and authorized for fiscal year 2020, prior to the due date for such fees, and that amounts of such fees assessed for fiscal year 2020 for which the Secretary accepts payment in fiscal year 2019 shall not be included in amounts in this paragraph.
      
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â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)
                  
                  
                  â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:
                  
                  
                  â60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  
                  
                  â60
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
          The FY 2019 Budget proposes to reauthorize the expiring fee programs and propose a new fee program. The budget includes a
            total of $25 million in animal drug fees and $13 million in animal generic drug fees. FDA also proposes reforms to the Over-the-Counter
            Monograph program and includes a total of $22 million in new over-the-counter drug fees. The proposed legislation authorizes
            the collection and spending of these fees subject to appropriations. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  
                  12
               
               
                  11.3
                  Other than full-time permanent
                  
                  
                  2
               
               
                  11.5
                  Other personnel compensation
                  
                  
                  1
               
               
                  11.7
                  Military personnel
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  16
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  5
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  3
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  19
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  11
               
               
                  25.5
                  Research and development contracts
                  
                  
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  60
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9911â2â1â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  144
               
               
                  2101
                  Reimbursable military average strength employment
                  
                  
                  9
               
               
                  
                     
                  
               
            
         
      
         FDA Working Capital Fund                                                                                                 
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4613â0â4â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1121
                  Appropriations transferred from other acct [075â9911]
                  
                  
                  5
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  5
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  5
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  5
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  5
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Payment to the FDA Innovation Account, CURES Act                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0148â0â1â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)
                  â20
                  â60
                  â70
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  20
                  60
                  70
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  20
                  60
                  70
               
               
                  4180
                  Budget authority, net (total)
                  20
                  60
                  70
               
               
                  4190
                  Outlays, net (total)
                  20
                  60
                  70
               
               
                  
                     
                  
               
            
         
      
      
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         FDA Innovation, CURES Act For necessary expenses to carry out the purposes described under section 1002(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes under the heading "Salaries and Expenses", $70,000,000, to remain available until expended: Provided, That amounts appropriated in this paragraph are appropriated pursuant to section 1002(b)(3) of the 21st Century Cures Act,
            are to be derived from amounts transferred under section 1002(b)(2)(A) of such Act, and may be transferred by the Secretary
            of Health and Human Services to other accounts of the Department solely for the purposes provided in such Act: Provided further, That such transfer authority is in addition to any other transfer authority provided by law.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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
                  â20
                  â20
                  â70
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  40
                  40
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â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 [075â9911]
                  
                  â20
                  â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)
                  â4
                  â8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  8
                  
               
               
                  3200
                  Obligated balance, end of year
                  8
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  20
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4
                  
                  
               
               
                  4011
                  Outlays from discretionary balances
                  
                  8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4
                  8
                  
               
               
                  4180
                  Budget authority, net (total)
                  20
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  4
                  8
                  
               
               
                  
                     
                  
               
            
         
      
      
         The 21st Century Cures Act was enacted into law on December 13, 2016. The Act includes authorities FDA can use to help modernize
            drug, biological, and device product development and review, and to create greater efficiencies and predictability in product
            development and review.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  3
                  
                  
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  12
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5629â0â2â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  26
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Revolving Fund for Certification and Other Services                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â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
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  9
                  10
                  10
               
               
                  1900
                  Budget authority (total)
                  9
                  10
                  10
               
               
                  1930
                  Total budgetary resources available
                  14
                  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)
                  â9
                  â14
                  â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
                  â9
                  â10
                  â9
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  1
               
               
                  4190
                  Outlays, net (total)
                  
                  4
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  
               
               
                  
                     
                  
               
            
         
      
      
         FDA certifies color additives for use in foods, drugs, and cosmetics. It also lists color additives for use in foods, drugs,
            medical devices, and cosmetics. These services are financed wholly by fees paid by the industries affected.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  5
                  5
                  5
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4309â0â3â554
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  40
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services Administration                                                                             
            
         Federal Funds
         Primary health careFor carrying out titles II and III of the Public Health Service Act (referred to in this Act as the "PHS Act") with respect
            to primary health care and the Native Hawaiian Health Care Act of 1988, $1,491,522,000: Provided, That no more than $1,000,000 shall be available until expended for carrying out the provisions of section 224(o) of the PHS Act: Provided further, That no more than $99,893,000 shall be available until expended for carrying out subsections (g) through (n) and (q) of section 224 of the PHS Act, and
            for expenses incurred by the Department of Health and Human Services (referred to in this Act as "HHS") pertaining to administrative
            claims made under such law: Provided further, That the ninth provisos under the heading "Department of Health and Human ServicesâHealth Resources and
               Services AdministrationâHealth Resources and Services" in Public Laws 104â208 and 105â78 are amended by striking "$80,000,000"
               and inserting "$152,700,000" in each such ninth proviso and by adding at the end of each such ninth proviso the following
               new proviso: "Provided further, That such costs, including the cost of modifying such loans, shall be as defined in section
               502 of the Congressional Budget Act of 1974:".
      
         Health workforceFor carrying out titles III, VII, and VIII of the PHS Act with respect to the health workforce, sections 1128E and 1921(b)
            of the Social Security Act, and the Health Care Quality Improvement Act of 1986, $87,798,000: Provided, That sections 751 and 762(k) of the PHS Act shall not apply to funds made available under this heading: Provided further, That fees collected for the disclosure of information under section 427(b) of the Health Care Quality Improvement Act of
            1986 and sections 1128E(d)(2) and 1921 of the Social Security Act shall be sufficient to recover the full costs of operating
            the programs authorized by such sections and shall remain available until expended for the National Practitioner Data Bank:
            Provided further, That funds transferred to this account to carry out section 846 and subpart 3 of part D of title III of the PHS Act may
            be used to make prior year adjustments to awards made under such sections.
      
         maternal and child healthFor carrying out titles III, XI, XII, and XIX of the PHS Act with respect to maternal and child health, title V of the Social
            Security Act, and section 712 of the American Jobs Creation Act of 2004, $731,200,000: Provided, That notwithstanding sections 502(a)(1) and 502(b)(1) of the Social Security Act, not more than $66,593,000 shall be available for carrying out special projects of regional and national significance pursuant to section 501(a)(2)
            of such Act and $10,276,000 shall be available for projects described in subparagraphs (A) through (F) of section 501(a)(3) of such Act.
      
         Ryan white HIV/AIDS programFor carrying out title XXVI of the PHS Act with respect to the Ryan White HIV/AIDS program, $2,260,170,000, of which $1,970,881,000 shall remain available to the Secretary of Health and Human Services (referred to in this title as the "Secretary") through
            September 30, 2021, for parts A and B of title XXVI of the PHS Act, and of which not less than $900,313,000 shall be for State AIDS Drug Assistance Programs under the authority of section 2616 or 311(c) of such Act: Provided, That section 2691 of the PHS Act shall not apply to funds appropriated under this heading.
      
         health care systemsFor carrying out titles III and XII of the PHS Act with respect to health care systems, and the Stem Cell Therapeutic and
            Research Act of 2005, $100,518,000: Provided, That the Secretary may collect a fee of 0.1 percent of each purchase of 340B drugs from entities participating
               in the Drug Pricing Program pursuant to section 340B of the PHS Act to pay for the operating costs of such program: Provided
               further, That fees pursuant to the 340B Drug Pricing Program shall be collected by the Secretary based on sales data that
               shall be submitted by drug manufacturers and shall be credited to this account, to remain available until expended. 
      
         Rural healthFor carrying out titles III and IV of the PHS Act with respect to rural health, section 427(a) of the Federal Coal Mine Health
            and Safety Act of 1969, and section 711 of the Social Security Act, $74,911,000.
      
         Family PlanningFor carrying out the program under title X of the PHS Act to provide for voluntary family planning projects, $286,479,000: Provided, That amounts provided to said projects under such title shall not be expended for abortions, that all pregnancy counseling
            shall be nondirective, and that such amounts shall not be expended for any activity (including the publication or distribution
            of literature) that in any way tends to promote public support or opposition to any legislative proposal or candidate for
            public office.
      
         program managementFor program support in the Health Resources and Services Administration, $151,993,000: Provided, That funds made available under this heading may be used to supplement program support funding provided under the headings
            "Primary Health Care", "Health Workforce", "Maternal and Child Health", "Ryan White HIV/AIDS Program", "Health Care Systems",
            and "Rural Health".
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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 [075â1503]
                  â2
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [015â5606]
                  
                  â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 [075â1503]
                  â14
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  6,199
                  6,156
                  5,185
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3,975
                  645
                  
               
               
                  1220
                  Appropriations transferred to other acct [015â5606]
                  â5
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â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
                  â2
                  â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
                  â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)
                  â10,236
                  â8,858
                  â6,457
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â84
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â135
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,626
                  5,702
                  4,492
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â22
                  â15
                  â15
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â10
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  17
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â15
                  â15
                  â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
                  â13
                  â11
                  â3
               
               
                  4033
                  Non-Federal sources
                  â17
                  â19
                  â19
               
               
                  4033
                  Non-Federal sources
                  
                  
                  â16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â30
                  â30
                  â38
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â31
                  â20
                  â20
               
               
                  4180
                  Budget authority, net (total)
                  10,054
                  6,802
                  5,186
               
               
                  4190
                  Outlays, net (total)
                  10,175
                  8,808
                  6,399
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  2
                  2
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  2
                  1
                  
               
               
                  5103
                  Unexpired unavailable balance, SOY: Fulfilled purpose
                  1
                  1
                  
               
               
                  5104
                  Unexpired unavailable balance, EOY: Fulfilled purpose
                  1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  10,054
                  6,802
                  5,186
               
               
                  
                  Outlays
                  10,175
                  8,808
                  6,399
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  3,330
                  3,970
               
               
                  
                  Outlays
                  
                  1,457
                  3,508
               
               
                  Total:
               
               
                  
                  Budget Authority
                  10,054
                  10,132
                  9,156
               
               
                  
                  Outlays
                  10,175
                  10,265
                  9,907
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â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
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  235999
                  Total guaranteed loan reestimates
                  â1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
            activities include support for Health Centers, treatment and care for those living with HIV/AIDS, health workforce training,
            maternal and child health care services, promotion of organ and bone marrow donation, rural health activities, and the medical
            malpractice claims funds, which pay malpractice claims filed against employees of federally-supported health centers and free
            clinics. HRSA is also responsible for oversight of the 340B Drug Discount Program.
         
         
            
               
                  
                     
                        
                     
                  
                  
                      
                  
                  
                     
                        
                     
                  
                  
                     
                  
                  
                     
                        
                     
                  
               
            
         
         HRSA 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 2016â2017 data reported in the Annual Operating Report.
         
         Health Professions Revolving Loan Programs Federal Capital Contribution
         
            
               
                  
                     
                        
                     
                  
                  
                     Program
                     Account Balance
                  
                  
                     
                        
                     
                  
                  
                     
                     
                  
                  
                     HPSL
                     416,265,386
                  
                  
                     NSL
                     188,621,972
                  
                  
                     PCL
                     239,076,684
                  
                  
                     LDS
                     157,612,046
                  
                  
                     
                     
                        
                     
                  
                  
                     Total
                     1,001,576,088
                  
                  
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  195
                  161
                  145
               
               
                  11.3
                  Other than full-time permanent
                  8
                  7
                  6
               
               
                  11.5
                  Other personnel compensation
                  4
                  3
                  3
               
               
                  11.7
                  Military personnel
                  21
                  18
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  228
                  189
                  171
               
               
                  12.1
                  Civilian personnel benefits
                  65
                  53
                  48
               
               
                  12.2
                  Military personnel benefits
                  11
                  10
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  3
                  2
               
               
                  23.1
                  Rental payments to GSA
                  20
                  17
                  14
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  10
                  8
                  6
               
               
                  25.1
                  Advisory and assistance services
                  13
                  14
                  11
               
               
                  25.2
                  Other services from non-Federal sources
                  224
                  198
                  183
               
               
                  25.3
                  Other goods and services from Federal sources
                  287
                  178
                  145
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.6
                  Medical care
                  3
                  3
                  3
               
               
                  25.7
                  Operation and maintenance of equipment
                  8
                  5
                  4
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  9
                  9
                  8
               
               
                  41.0
                  Grants, subsidies, and contributions
                  9,286
                  6,103
                  4,492
               
               
                  42.0
                  Insurance claims and indemnities
                  120
                  88
                  88
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  10,290
                  6,881
                  5,187
               
               
                  99.0
                  Reimbursable obligations
                  73
                  53
                  60
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  10,363
                  6,934
                  5,247
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â0â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,826
                  1,485
                  1,336
               
               
                  1101
                  Direct military average strength employment
                  205
                  173
                  155
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  57
                  57
                  57
               
               
                  2101
                  Reimbursable military average strength employment
                  4
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Health Resources and Services                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â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 [015â5606]
                  
                  
                  â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)
                  
                  â1,457
                  â3,508
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  1,873
                  2,335
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  1,873
               
               
                  3200
                  Obligated balance, end of year
                  
                  1,873
                  2,335
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  3,330
                  3,970
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1,457
                  1,747
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  1,761
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  1,457
                  3,508
               
               
                  4180
                  Budget authority, net (total)
                  
                  3,330
                  3,970
               
               
                  4190
                  Outlays, net (total)
                  
                  1,457
                  3,508
               
               
                  
                     
                  
               
            
         
      
      
         Resources displayed here support grants and contracts managed by Health Resources and Services Administration (HRSA). These
            activities include support for Health Centers, health workforce programs, and maternal and child health care services.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  38
                  45
               
               
                  11.3
                  Other than full-time permanent
                  
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  
                  1
                  1
               
               
                  11.7
                  Military personnel
                  
                  3
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  43
                  51
               
               
                  12.1
                  Civilian personnel benefits
                  
                  12
                  15
               
               
                  12.2
                  Military personnel benefits
                  
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  
                  2
                  4
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  2
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  28
                  28
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  106
                  107
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  3
                  3
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  3,132
                  3,758
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  3,330
                  3,970
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0350â4â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  341
                  419
               
               
                  1101
                  Direct military average strength employment
                  
                  32
                  40
               
               
                  
                     
                  
               
            
         
      
         Vaccine Injury Compensation                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0320â0â1â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
                  â2
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â2
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â2
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Vaccine Injury Compensation Program was established pursuant to Public Law 99â660 and Public Law 100â203, and serves as
            a source of funds to pay claims for compensation for vaccine related injury or death. Payment of claims associated with vaccine
            related injury or death occurring before October 1, 1988, are financed from the General Fund and are reflected in this account.
            Given sufficient carry-over funds from prior years' appropriations to pay for the balance of the pre-1988 claims yet to be
            adjudicated, no appropriation is requested to cover payment of pre-1988 claims. By statute, no new claims are accepted for
            this account. Payment of claims associated with vaccine related injury or death occurring after October 1, 1988, are reflected
            in the Vaccine Injury Compensation Program trust fund account.
         
      
         Covered Countermeasure Process Fund                                                                                      
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  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 [075â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)
                  â2
                  â3
                  â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 109â148, to serve as a source of funds to pay for compensation for injuries, illnesses or death, or losses
            resulting from the administration to or use by an individual of a covered countermeasure for which a Secretarial Declaration
            has been issued, pursuant to section 319F-3(b) of the PHS Act. Additionally, authority is provided to address any unexpected
            claims that may arise under the Smallpox Emergency Personnel Protection Act of 2003 (P.L. 108â20).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  1
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0343â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  4
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â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
                  â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)
                  â416
                  â372
                  â269
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  719
                  360
                  91
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  739
                  719
                  360
               
               
                  3200
                  Obligated balance, end of year
                  719
                  360
                  91
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  372
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  11
                  
                  
               
               
                  4101
                  Outlays from mandatory balances
                  405
                  372
                  269
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  416
                  372
                  269
               
               
                  4180
                  Budget authority, net (total)
                  372
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  416
                  372
                  269
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  372
                  
                  
               
               
                  
                  Outlays
                  416
                  372
                  269
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  400
                  400
               
               
                  
                  Outlays
                  
                  16
                  120
               
               
                  Total:
               
               
                  
                  Budget Authority
                  372
                  400
                  400
               
               
                  
                  Outlays
                  416
                  388
                  389
               
               
                  
                     
                  
               
            
         
      
      
         The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
            activities are administered by HRSA.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  5
                  5
                  
               
               
                  11.7
                  Military personnel
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  6
                  6
                  
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  
               
               
                  25.1
                  Advisory and assistance services
                  25
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  375
                  5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  408
                  13
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  40
                  40
                  
               
               
                  1101
                  Direct military average strength employment
                  3
                  3
                  
               
               
                  
                     
                  
               
            
         
      
         Maternal, Infant, and Early Childhood Home Visiting Programs                                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â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)
                  
                  â16
                  â120
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  384
                  664
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  384
               
               
                  3200
                  Obligated balance, end of year
                  
                  384
                  664
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  400
                  400
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  16
                  16
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  104
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  16
                  120
               
               
                  4180
                  Budget authority, net (total)
                  
                  400
                  400
               
               
                  4190
                  Outlays, net (total)
                  
                  16
                  120
               
               
                  
                     
                  
               
            
         
      
      
         The Maternal, Infant and Early Childhood Home Visiting Program provides comprehensive services for at risk communities. These
            activities are administered by HRSA.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  
                  
                  5
               
               
                  11.7
                  Military personnel
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  6
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  2
               
               
                  25.1
                  Advisory and assistance services
                  
                  25
                  25
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  375
                  367
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  400
                  400
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0321â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  40
               
               
                  1101
                  Direct military average strength employment
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
         Health Center Guaranteed Loan Financing Account                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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)
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  1
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Status of Guaranteed Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â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
                  â6
                  â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
                  â5
                  â10
                  â10
               
               
                  
                  Adjustments:
               
               
                  2263
                  Terminations for default that result in claim payments
                  
                  â1
                  â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 104â299 and Public Law 104â208 authorize Health Resources and Services Administration (HRSA) to guarantee up to
            $160 million in private loans to health centers for the costs of developing and operating managed care networks or plans and
            for the construction, renovation, and modernization of medical facilities. The program account for this activity is displayed
            in the Health Resources and Services account (75â0350) as a line in the program and financing schedule.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4442â0â3â551
                  2016 actual
                  2017 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  2
                  2
               
               
                  
                  LIABILITIES:
               
               
                  2204
                  Non-Federal liabilities: Liabilities for loan guarantees
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Medical Facilities Guarantee and Loan Fund                                                                               
            
         Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â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
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
      
         Titles VI and XVI of the PHS Act established a loan and loan guarantee fund for medical facilities with a maximum amount allowable
            for the Government's liability. Direct loans were made available for public facilities and guaranteed loans for private, nonprofit
            facilities. Funds under this authority were established in the amount of $50 million for use in fulfilling guarantees in the
            event of default, $30 million as a revolving fund for direct loans, and an amount for interest subsidy payments on guaranteed
            loans.
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9931â0â3â551
                  2016 actual
                  2017 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1601
                  Direct loans, gross
                  6
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  6
                  5
               
               
                  
                  LIABILITIES:
               
               
                  2201
                  Non-Federal liabilities: Accounts payable
                  6
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  6
                  5
               
               
                  
                     
                  
               
            
         
      
      Trust Funds  
         Vaccine injury compensation program trust fundFor payments from the Vaccine Injury Compensation Program Trust Fund (the "Trust Fund"), such sums as may be necessary for
            claims associated with vaccine-related injury or death with respect to vaccines administered after September 30, 1988, pursuant
            to subtitle 2 of title XXI of the PHS Act, to remain available until expended: Provided, That for necessary administrative expenses, not to exceed $9,200,000 shall be available from the Trust Fund to the Secretary.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â24
                  â24
                  â27
               
               
                  2101
                  Vaccine Injury Compensation Program Trust Fund
                  â282
                  â308
                  â308
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â306
                  â332
                  â335
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â306
                  â332
                  â335
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  3,619
                  3,689
                  3,771
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â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
                  â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)
                  â307
                  â341
                  â335
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â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
                  â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 99â660 and Public Law 100â203 and serves as
            a source of funds to pay claims for compensation for vaccine-related injury or death. This account reflects payments for claims
            for vaccine-related injury or death occurring after October 1, 1988.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  2
                  2
                  2
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  4
                  4
                  4
               
               
                  42.0
                  Insurance claims and indemnities
                  299
                  325
                  328
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  306
                  332
                  335
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8175â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  14
                  14
                  16
               
               
                  1101
                  Direct military average strength employment
                  6
                  6
                  6
               
               
                  
                     
                  
               
            
         
      
         Indian Health Service                                                                                                    
            
         Federal Funds
         Indian health servicesFor expenses necessary to carry out the Act of August 5, 1954 (68 Stat. 674), the Indian Self-Determination and Education
            Assistance Act, the Indian Health Care Improvement Act, and titles II and III of the Public Health Service Act with respect
            to the Indian Health Service, $3,850,529,000, together with payments received during the fiscal year pursuant to 42 U.S.C. 238(b) and 238b, for services furnished by
            the Indian Health Service: Provided, That funds made available to tribes and tribal organizations through contracts, grant agreements, or any other agreements
            or compacts authorized by the Indian Self-Determination and Education Assistance Act of 1975 (25 U.S.C. 450), shall be deemed
            to be obligated at the time of the grant or contract award and thereafter shall remain available to the tribe or tribal organization
            without fiscal year limitation: Provided further, That, $932,492,000 for Purchased/Referred Care, including  $51,500,000 for the Indian Catastrophic Health Emergency Fund, shall remain available until expended: Provided further, That, of the funds provided, up to $36,000,000 shall remain available until expended for implementation of the loan repayment program under section 108 of the Indian Health
            Care Improvement Act: Provided further, That, of the funds provided, $11,000,000 shall remain available until expended to supplement funds available for operational costs at tribal clinics operated under
            an Indian Self-Determination and Education Assistance Act compact or contract where health care is delivered in space acquired
            through a full service lease, which is not eligible for maintenance and improvement and equipment funds from the Indian Health
            Service, and not less than $58,000,000 shall be for accreditation emergencies, including supplementing activities funded under the heading "Indian Health Facilities":  Provided further, That the amounts collected by the Federal Government as authorized by sections 104 and 108 of the Indian Health Care Improvement
            Act (25 U.S.C. 1613a and 1616a) during the preceding fiscal year for breach of contracts shall be deposited in the Fund authorized by section 108A of the Act (25 U.S.C. 1616a-1) and shall remain available until expended and, notwithstanding
            section 108A(c) of the Act (25 U.S.C. 1616a-1(c)), funds shall be available to make new awards under the loan repayment and
            scholarship programs under sections 104 and 108 of the Act (25 U.S.C. 1613a and 1616a): Provided further, That, notwithstanding any other provision of law, the amounts made available within this account for the Substance Abuse
            and Suicide Prevention Program, for the Domestic Violence Prevention Program, to improve collections from public and private
            insurance at Indian Health Service and tribally operated facilities, and for accreditation emergencies shall be allocated
            at the discretion of the Director of the Indian Health Service and shall remain available until expended: Provided further, That funds provided in this Act may be used for annual contracts and grants that fall within 2 fiscal years, provided the
            total obligation is recorded in the year the funds are appropriated: Provided further, That the amounts collected by the Secretary of Health and Human Services under the authority of title IV of the Indian Health
            Care Improvement Act shall remain available until expended for the purpose of achieving compliance with the applicable conditions
            and requirements of titles XVIII and XIX of the Social Security Act, except for those related to the planning, design, or
            construction of new facilities: Provided further, That funding contained herein for scholarship programs under the Indian Health Care Improvement Act (25 U.S.C. 1613) shall
            remain available until expended: Provided further, That amounts received by tribes and tribal organizations under title IV of the Indian Health Care Improvement Act shall
            be reported and accounted for and available to the receiving tribes and tribal organizations until expended: Provided further, That the Bureau of Indian Affairs may collect from the Indian Health Service, tribes and tribal organizations operating
            health facilities pursuant to Public Law 93â638, such individually identifiable health information relating to disabled children
            as may be necessary for the purpose of carrying out its functions under the Individuals with Disabilities Education Act (20
            U.S.C. 1400, et seq.): Provided further, That the Indian Health Care Improvement Fund may be used, as needed, to carry out activities typically funded under the
            Indian Health Facilities account.
      Note.âA full-year 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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â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
                  â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
                  â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)
                  â5,164
                  â5,446
                  â5,273
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â192
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â33
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,034
                  600
                  520
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â98
                  â100
                  â100
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â100
                  â100
                  â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
                  â476
                  â276
                  â276
               
               
                  4033
                  Non-Federal sources
                  â1,075
                  â1,172
                  â1,174
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,551
                  â1,448
                  â1,450
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â3
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  4
                  
                  
               
               
                  4053
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  3,694
                  3,681
                  3,850
               
               
                  4080
                  Outlays, net (discretionary)
                  3,473
                  3,920
                  3,820
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  148
                  75
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  47
                  72
                  
               
               
                  4101
                  Outlays from mandatory balances
                  93
                  6
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  140
                  78
                  3
               
               
                  4180
                  Budget authority, net (total)
                  3,842
                  3,756
                  3,850
               
               
                  4190
                  Outlays, net (total)
                  3,613
                  3,998
                  3,823
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  3,842
                  3,756
                  3,850
               
               
                  
                  Outlays
                  3,613
                  3,998
                  3,823
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  75
                  150
               
               
                  
                  Outlays
                  
                  72
                  147
               
               
                  Total:
               
               
                  
                  Budget Authority
                  3,842
                  3,831
                  4,000
               
               
                  
                  Outlays
                  3,613
                  4,070
                  3,970
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Services account provides medical care, public health services, and health professions training opportunities
            to American Indians and Alaska Natives. More than $2.2 billion, primarily through self-determination contracts and compacts,
            will be administered by tribal governments in 2019.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  397
                  397
                  415
               
               
                  11.3
                  Other than full-time permanent
                  18
                  18
                  19
               
               
                  11.5
                  Other personnel compensation
                  60
                  60
                  62
               
               
                  11.7
                  Military personnel
                  62
                  62
                  65
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  537
                  537
                  561
               
               
                  12.1
                  Civilian personnel benefits
                  159
                  159
                  167
               
               
                  12.2
                  Military personnel benefits
                  27
                  27
                  28
               
               
                  13.0
                  Benefits for former personnel
                  10
                  10
                  10
               
               
                  21.0
                  Patient travel
                  43
                  43
                  44
               
               
                  22.0
                  Transportation of things
                  7
                  7
                  8
               
               
                  23.1
                  Rental payments to GSA
                  16
                  16
                  17
               
               
                  23.2
                  Rental payments to others
                  2
                  2
                  2
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  13
                  13
                  14
               
               
                  25.1
                  Advisory and assistance services
                  6
                  6
                  6
               
               
                  25.2
                  Other services from non-Federal sources
                  105
                  104
                  110
               
               
                  25.3
                  Other goods and services from Federal sources
                  76
                  76
                  84
               
               
                  25.4
                  Operation and maintenance of facilities
                  2
                  2
                  2
               
               
                  25.6
                  Medical care
                  380
                  377
                  382
               
               
                  25.7
                  Operation and maintenance of equipment
                  14
                  14
                  15
               
               
                  25.8
                  Subsistence and support of persons
                  3
                  3
                  3
               
               
                  26.0
                  Supplies and materials
                  92
                  91
                  100
               
               
                  31.0
                  Equipment
                  12
                  12
                  13
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,337
                  2,319
                  2,433
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  3,841
                  3,819
                  4,000
               
               
                  99.0
                  Reimbursable obligations
                  1,557
                  1,193
                  1,193
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  5,398
                  5,012
                  5,193
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  6,705
                  6,705
                  7,204
               
               
                  1101
                  Direct military average strength employment
                  932
                  932
                  964
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  5,684
                  6,584
                  5,710
               
               
                  2101
                  Reimbursable military average strength employment
                  790
                  790
                  764
               
               
                  
                     
                  
               
            
         
      
         Indian Health Services                                                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â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)
                  
                  â72
                  â147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  3
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  3
               
               
                  3200
                  Obligated balance, end of year
                  
                  3
                  6
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  75
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  72
                  144
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  72
                  147
               
               
                  4180
                  Budget authority, net (total)
                  
                  75
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  72
                  147
               
               
                  
                     
                  
               
            
         
      
      
         This activity supports evidence-based diabetes treatment and prevention services across Indian Country.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0390â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  21.0
                  Patient travel
                  
                  1
                  2
               
               
                  22.0
                  Transportation of things
                  
                  
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  3
                  5
               
               
                  25.4
                  Operation and maintenance of facilities
                  
                  2
                  3
               
               
                  25.6
                  Medical care
                  
                  10
                  20
               
               
                  25.7
                  Operation and maintenance of equipment
                  
                  
                  1
               
               
                  26.0
                  Supplies and materials
                  
                  3
                  5
               
               
                  31.0
                  Equipment
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  56
                  112
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  75
                  150
               
               
                  
                     
                  
               
            
         
      
         Contract support costsFor payments to tribes and tribal organizations for contract support costs associated with Indian Self-Determination and Education
            Assistance Act agreements with the Indian Health Service for fiscal year 2019, such sums as may be necessary: Provided, That amounts obligated but not expended by a tribe or tribal organization for contract support costs for such agreements
            for the current fiscal year shall be applied to contract support costs otherwise due for such agreements for subsequent fiscal
            years: Provided further, That, notwithstanding any other provision of law, no amounts made available under this heading shall be available for transfer
            to another budget account.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0344â0â1â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)
                  â716
                  â843
                  â797
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â49
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  48
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  39
                  48
                  
               
               
                  3200
                  Obligated balance, end of year
                  48
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  712
                  795
                  797
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  688
                  795
                  797
               
               
                  4011
                  Outlays from discretionary balances
                  28
                  48
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  716
                  843
                  797
               
               
                  4180
                  Budget authority, net (total)
                  712
                  795
                  797
               
               
                  4190
                  Outlays, net (total)
                  716
                  843
                  797
               
               
                  
                     
                  
               
            
         
      
      
         The Contract Support Costs account provides for the reasonable and allowable costs for direct program expenses for the operation
            of, and any additional administrative or other expense related to, the overhead incurred by tribes and tribal organizations
            who operate health programs through self-determination contracts and compacts. An estimated $797 million in contract support
            costs funds will be provided to tribal governments and tribal organizations in 2019.
         
      
         Indian health facilitiesFor construction, repair, maintenance, improvement, and equipment of health and related auxiliary facilities, including quarters
            for personnel; preparation of plans, specifications, and drawings; acquisition of sites, purchase and erection of modular
            buildings, and purchases of trailers; and for provision of domestic and community sanitation facilities for Indians, as authorized
            by section 7 of the Act of August 5, 1954 (42 U.S.C. 2004a), the Indian Self-Determination Act, and the Indian Health Care
            Improvement Act, and for expenses necessary to carry out such Acts and titles II and III of the Public Health Service Act
            with respect to environmental health and facilities support activities of the Indian Health Service,  $426,267,000, to remain available until expended: Provided, That, notwithstanding any other provision of law, funds appropriated for the planning, design, construction, renovation
            or expansion of health facilities for the benefit of an Indian tribe or tribes may be used to purchase land on which such
            facilities will be located: Provided further, That not to exceed $500,000 may be used by the Indian Health Service to purchase TRANSAM equipment from the Department of
            Defense for distribution to the Indian Health Service and tribal facilities: Provided further, That none of the funds appropriated to the Indian Health Service may be used for sanitation facilities construction for
            new homes funded with grants by the housing programs of the United States Department of Housing and Urban Development: Provided further, That not to exceed $2,700,000 from this account and the "Indian Health Services" account may be used by the Indian Health
            Service to obtain ambulances for the Indian Health Service and tribal facilities in conjunction with an existing interagency
            agreement between the Indian Health Service and the General Services Administration: Provided further, That not to exceed $500,000 may be placed in a Demolition Fund, to remain available until expended, and be used by the Indian
            Health Service for the demolition of Federal buildings.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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
                  â8
                  â9
                  â9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â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)
                  â478
                  â593
                  â570
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  575
                  532
                  398
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â8
                  â9
                  â9
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â9
                  â9
                  â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
                  â32
                  â57
                  â57
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â32
                  â57
                  â57
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  545
                  541
                  427
               
               
                  4080
                  Outlays, net (discretionary)
                  437
                  527
                  504
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8
                  9
                  9
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3
                  9
                  9
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  9
                  9
                  9
               
               
                  4180
                  Budget authority, net (total)
                  553
                  550
                  436
               
               
                  4190
                  Outlays, net (total)
                  446
                  536
                  513
               
               
                  
                     
                  
               
            
         
      
      
         The Indian Health Facilities account supports construction, repair and improvement, equipment, and environmental health and
            facilities support for the Indian Health Service. More than 169 million, primarily through self-determination contracts and
            compacts, will be administered by tribal governments in 2019.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  51
                  51
                  57
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  3
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  22
                  22
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  78
                  78
                  83
               
               
                  12.1
                  Civilian personnel benefits
                  18
                  18
                  20
               
               
                  12.2
                  Military personnel benefits
                  8
                  8
                  9
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  3
                  2
               
               
                  22.0
                  Transportation of things
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  14
                  15
                  12
               
               
                  25.1
                  Advisory and assistance services
                  3
                  3
                  2
               
               
                  25.2
                  Other services from non-Federal sources
                  109
                  108
                  71
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  3
                  2
               
               
                  25.4
                  Operation and maintenance of facilities
                  8
                  8
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  4
                  4
                  3
               
               
                  25.8
                  Subsistence and support of persons
                  8
                  8
                  5
               
               
                  26.0
                  Supplies and materials
                  7
                  7
                  6
               
               
                  31.0
                  Equipment
                  13
                  13
                  10
               
               
                  32.0
                  Land and structures
                  80
                  79
                  55
               
               
                  41.0
                  Grants, subsidies, and contributions
                  189
                  182
                  137
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  548
                  541
                  427
               
               
                  99.0
                  Reimbursable obligations
                  25
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  573
                  550
                  436
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0391â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  968
                  968
                  976
               
               
                  1101
                  Direct military average strength employment
                  147
                  147
                  141
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  37
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         ADMINISTRATIVE PROVISIONSâINDIAN HEALTH SERVICE                                                                          
            
         
         Administrative provisionsâindian health serviceAppropriations provided in this Act to the Indian Health Service shall be available for services as authorized by 5 U.S.C.
            3109 at rates not to exceed the per diem rate equivalent to the maximum rate payable for senior-level positions under 5 U.S.C.
            5376; hire of passenger motor vehicles and aircraft; purchase of medical equipment; purchase of reprints; purchase, renovation
            and erection of modular buildings and renovation of existing facilities; payments for telephone service in private residences
            in the field, when authorized under regulations approved by the Secretary; uniforms or allowances therefor as authorized by
            5 U.S.C. 5901â5902; and for expenses of attendance at meetings that relate to the functions or activities of the Indian Health
            Service: Provided, That in accordance with the provisions of the Indian Health Care Improvement Act, non-Indian patients may be extended health
            care at all tribally administered or Indian Health Service facilities, subject to charges, and the proceeds along with funds
            recovered under the Federal Medical Care Recovery Act (42 U.S.C. 2651â2653) shall be credited to the account of the facility
            providing the service and shall be available without fiscal year limitation: Provided further, That notwithstanding any other law or regulation, funds transferred from the Department of Housing and Urban Development
            to the Indian Health Service shall be administered under Public Law 86â121, the Indian Sanitation Facilities Act and Public
            Law 93â638: Provided further, That funds appropriated to the Indian Health Service in this Act, except those used for administrative and program direction
            purposes, shall not be subject to limitations directed at curtailing Federal travel and transportation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used for any assessments or charges
            by the Department of Health and Human Services unless identified in the budget justification and provided in this Act, or
            the House and Senate Committees on Appropriations are notified through the reprogramming process: Provided further, That notwithstanding any other provision of law, funds previously or herein made available to a tribe or tribal organization
            through a contract, grant, or agreement authorized by title I or title V of the Indian Self-Determination and Education Assistance
            Act of 1975 (25 U.S.C. 450), may be deobligated and reobligated to a self-determination contract under title I, or a self-governance
            agreement under title V of such Act and thereafter shall remain available to the tribe or tribal organization without fiscal
            year limitation: Provided further, That none of the funds made available to the Indian Health Service in this Act shall be used to implement the final rule
            published in the Federal Register on September 16, 1987, by the Department of Health and Human Services, relating to the eligibility
            for the health care services of the Indian Health Service until the Indian Health Service has submitted a budget request reflecting
            the increased costs associated with the proposed final rule, and such request has been included in an appropriations Act and
            enacted into law: Provided further, That with respect to functions transferred by the Indian Health Service to tribes or tribal organizations, the Indian Health
            Service is authorized to provide goods and services to those entities on a reimbursable basis, including payments in advance
            with subsequent adjustment, and the reimbursements received therefrom, along with the funds received from those entities pursuant
            to the Indian Self-Determination Act, may be credited to the same or subsequent appropriation account from which the funds
            were originally derived, with such amounts to remain available until expended: Provided further, That reimbursements for training, technical assistance, or services provided by the Indian Health Service will contain total
            costs, including direct, administrative, and overhead associated with the provision of goods, services, or technical assistance:
            Provided further, That, notwithstanding any other provision of law, for any lease under section 105(l) of the Indian Self-Determination and
            Education Assistance Act, as amended, no additional compensation is required by the Act above the amount provided to the tribe
            or tribal organization under section 106(a)(1), except the Secretary, in the discretion of the Secretary, may award compensation
            for such leases, above the section 106(a)(1) amount, and if the Secretary awards such additional compensation the amount of
            such compensation may be based on such reasonable expenses, if any, as the Secretary determines to be appropriate, which may
            include the expenses described in section 105(l)(2), and the exercise of this discretion to award additional compensation
            and determine its amount is not subject to sections 102(a)-(b), (e) or 507(b)-(d) of the Act.
      
         Centers for Disease Control and Prevention                                                                               
            
         Federal Funds
         Immunization and respiratory diseasesFor carrying out titles II, III, XVII, and XXI, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
            Act, and section 501 of the Refugee Education Assistance Act, with respect to immunization and respiratory diseases, $437,828,000.
      
         HIV/AIDS, viral hepatitis, sexually transmitted diseases, and tuberculosis preventionFor carrying out titles II, III, XVII, and XXIII of the PHS Act with respect to HIV/AIDS, viral hepatitis, sexually transmitted
            diseases, and tuberculosis prevention, $1,067,278,000.
      
         Emerging and zoonotic infectious diseasesFor carrying out titles II, III, and XVII, and section 2821 of the PHS Act, titles II and IV of the Immigration and Nationality
            Act, and section 501 of the Refugee Education Assistance Act, with respect to emerging and zoonotic infectious diseases, $371,328,000: Provided, That of the amounts available to pay for the transportation, medical care, treatment, and other related costs of persons
            quarantined or isolated under federal or state quarantine law, up to $1,000,000 shall remain available until expended.
      
         Chronic disease prevention and health promotionFor carrying out titles II, III, XI, XV, XVII, and XIX of the PHS Act with respect to chronic disease prevention and health
            promotion, $439,250,000: Provided, That amounts in this account, including amounts transferred to this account, are available for the Director of the Centers
            for Disease Control and Prevention (CDC) to administer a program, to be known as America's Health State Block Grant, to provide
            increased flexibility for States, territories, tribes, and tribal organizations to improve public health: Provided further, That for purposes of carrying out such program, the Director is hereby authorized to award grants to States, territories,
            tribes, and tribal organizations, and such grant awards shall be provided through a formula, as determined by the Director,
            that takes into account the population and disease burden of the grantee: Provided further, That the Director may set aside not more than 15 percent of the amounts awarded for grants described in the previous proviso
            for the same purposes, on a competitive basis, to cities, Federally-recognized tribes, and public health entities serving
            rural and frontier areas or other entities: Provided further, That funds appropriated under this account may be available for making grants under section 1509 of the PHS Act for not
            less than 21 States, tribes, or tribal organizations: Provided further, That the proportional funding requirements under section 1503(a) of the PHS Act shall not apply to funds made available
            under this heading.
      
         Birth defects, developmental disabilities, disabilities and healthFor carrying out titles II, III, XI, and XVII of the PHS Act with respect to birth defects, developmental disabilities, disabilities
            and health, $110,000,000.
      
         Public Health Scientific ServicesFor carrying out titles II, III, and XVII of the PHS Act with respect to health statistics, surveillance, health informatics,
            and workforce development, $332,180,000: Provided, That in addition to amounts provided herein, $135,820,000 shall be available from amounts available under section 241 of the PHS Act to carry out the Public Health Scientific Services.
      
         Environmental healthFor carrying out titles II, III, and XVII of the PHS Act with respect to environmental health, $157,000,000.
      
         Injury prevention and controlFor carrying out titles II, III, and XVII of the PHS Act with respect to injury prevention and control, $266,309,000.
      
         National Institute for Occupational Safety and Health 
      
         Energy employees occupational illness compensation program 
      
         Global healthFor carrying out titles II, III, and XVII of the PHS Act with respect to global health, $408,762,000, of which $69,547,000 for international HIV/AIDS  shall remain available through September 30, 2020 and $58,762,000 for global public health protection shall remain available through September 30, 2020: Provided, That funds may be used for purchase and insurance of official motor vehicles in foreign countries.
      
         public health preparedness and responseFor carrying out titles II, III, and XVII of the PHS Act with respect to public health preparedness and response, and for
            expenses necessary to support activities related to countering potential biological, nuclear, radiological, and chemical threats
            to civilian populations, $691,000,000: Provided, That the Director of the CDC or the Administrator of the Agency for Toxic Substances and Disease Registry may detail staff
            without reimbursement for up to 180 days to support an activation of the CDC Emergency Operations Center.
      
         cdc-wide activities and program supportFor carrying out titles II, III, XVII, and XIX, and section 2821 of the PHS Act and for cross-cutting activities and program
            support for activities funded in other appropriations included in this Act for the Centers for Disease Control and Prevention,
            $105,000,000: Provided, That paragraphs (1) through (3) of subsection (b) of section 2821 of the PHS Act shall not apply to funds appropriated under
            this heading and in all other accounts of the CDC: Provided further, That funds appropriated under this heading and in all other accounts of CDC may be used to support the purchase, hire, maintenance,
            and operation of aircraft for use and support of the activities of CDC:  Provided further, That employees of CDC or the Public Health Service, both civilian and commissioned officers, detailed to States, municipalities,
            or other organizations under authority of section 214 of the PHS Act, or in overseas assignments, shall be treated as non-Federal
            employees for reporting purposes only and shall not be included within any personnel ceiling applicable to the Agency, Service,
            or HHS during the period of detail or assignment: Provided further, That CDC may use up to $10,000 from amounts appropriated to CDC in this Act for official reception and representation expenses
            when specifically approved by the Director of CDC: Provided further, That in addition, such sums as may be derived from authorized user fees, which shall be credited to the appropriation charged
            with the cost thereof: Provided further, That with respect to the previous proviso, authorized user fees from the Vessel Sanitation Program and the Respirator Certification
            Program shall be available through September 30, 2020: Provided further, That the Director may transfer discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of
            1985) which are appropriated for the current fiscal year for CDC in this Act between any of the accounts of CDC with notification
            to the Committees on Appropriations of both Houses of Congress at least 15 days in advance of any transfer, but no such account
            shall be decreased by more than 3 percent by any such transfer.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â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
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  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 [075â0960]
                  â4
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â3
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â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 [075â1503]
                  â14
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct (CHIMPS) [075â0116]
                  
                  805
                  
               
               
                  1130
                  Appropriations permanently reduced
                  
                  â5
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  6,270
                  7,007
                  4,386
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (075â0954 - EEOICPA)
                  55
                  55
                  
               
               
                  1201
                  Appropriation (075â5146 CRADA)
                  1
                  2
                  2
               
               
                  1221
                  Appropriations transferred from other acct PPHF [075â0116]
                  891
                  
                  800
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â5
                  â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
                  â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)
                  â7,826
                  â8,071
                  â7,317
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â57
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â186
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,137
                  6,486
                  4,623
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â233
                  â190
                  â190
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â16
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  59
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â190
                  â190
                  â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
                  â222
                  â408
                  â408
               
               
                  4033
                  Non-Federal sources
                  â10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â232
                  â408
                  â408
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â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
                  â7
                  â4
                  â4
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  942
                  52
                  802
               
               
                  4170
                  Outlays, net (mandatory)
                  1,029
                  856
                  394
               
               
                  4180
                  Budget authority, net (total)
                  7,212
                  7,059
                  5,188
               
               
                  4190
                  Outlays, net (total)
                  7,587
                  7,659
                  6,905
               
               
                  
                     
                  
               
            
         
      
      
         The Centers for Disease Control and Prevention (CDC) supports a number of categorical programs designed to improve the health,
            safety, and protection of all Americans. These activities include immunization and respiratory diseases, HIV/AIDS, Hepatitis,
            STDs, and Tuberculosis prevention, emerging and zoonotic infectious diseases, chronic disease prevention and health promotion,
            public health and scientific services, injury prevention and control, environmental health, global health, programs that reduce
            the occurrence of birth defects and developmental disabilities, public health preparedness and emergency response, and CDC-wide
            activities and program support. The FY 2019 Budget maintains the proposal to establish a new block grant, proposed at $400
            million, to increase flexibility for States to address their population's unique public health needs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  759
                  801
                  803
               
               
                  11.3
                  Other than full-time permanent
                  117
                  101
                  102
               
               
                  11.5
                  Other personnel compensation
                  40
                  37
                  37
               
               
                  11.7
                  Military personnel
                  81
                  75
                  76
               
               
                  11.8
                  Special personal services payments
                  8
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,005
                  1,022
                  1,026
               
               
                  12.1
                  Civilian personnel benefits
                  301
                  307
                  309
               
               
                  12.2
                  Military personnel benefits
                  55
                  50
                  50
               
               
                  21.0
                  Travel and transportation of persons
                  60
                  42
                  32
               
               
                  22.0
                  Transportation of things
                  16
                  14
                  11
               
               
                  23.1
                  Rental payments to GSA
                  8
                  27
                  21
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  22
                  34
                  28
               
               
                  24.0
                  Printing and reproduction
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  876
                  865
                  334
               
               
                  25.2
                  Other services from non-Federal sources
                  177
                  224
                  74
               
               
                  25.3
                  Other goods and services from Federal sources
                  783
                  443
                  149
               
               
                  25.4
                  Operation and maintenance of facilities
                  17
                  21
                  10
               
               
                  25.5
                  Research and development contracts
                  28
                  26
                  8
               
               
                  25.6
                  Medical care
                  44
                  38
                  12
               
               
                  25.7
                  Operation and maintenance of equipment
                  51
                  86
                  29
               
               
                  26.0
                  Supplies and materials
                  515
                  472
                  401
               
               
                  31.0
                  Equipment
                  62
                  64
                  52
               
               
                  32.0
                  Land and structures
                  1
                  7
                  5
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,971
                  3,476
                  2,701
               
               
                  42.0
                  Insurance claims and indemnities
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  7,997
                  7,223
                  5,257
               
               
                  99.0
                  Reimbursable obligations
                  197
                  197
                  197
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  8,194
                  7,420
                  5,454
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0943â0â1â999
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  9,079
                  8,620
                  7,520
               
               
                  1101
                  Direct military average strength employment
                  858
                  788
                  694
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  218
                  218
                  218
               
               
                  2101
                  Reimbursable military average strength employment
                  37
                  37
                  37
               
               
                  
                     
                  
               
            
         
      
         buildings and facilitiesFor acquisition of real property, equipment, construction, demolition, and renovation of facilities, $20,000,000, to remain available until September 30, 2023.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â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 [075â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)
                  â7
                  â10
                  â14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  9
                  9
                  15
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7
                  9
                  9
               
               
                  3200
                  Obligated balance, end of year
                  9
                  9
                  15
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  10
                  10
                  20
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1
                  4
                  8
               
               
                  4011
                  Outlays from discretionary balances
                  6
                  6
                  6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  7
                  10
                  14
               
               
                  4180
                  Budget authority, net (total)
                  10
                  10
                  20
               
               
                  4190
                  Outlays, net (total)
                  7
                  10
                  14
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0960â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  1
                  1
                  1
               
               
                  25.4
                  Operation and maintenance of facilities
                  8
                  9
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  9
                  10
                  20
               
               
                  
                     
                  
               
            
         
      
         CDC Working Capital Fund                                                                                                 
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â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
                  â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)
                  â556
                  â534
                  â532
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  195
                  193
                  193
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2
                  â1
                  â1
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1
                  â1
                  â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
                  â537
                  â532
                  â532
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  19
                  2
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  19
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      
         Implemented in fiscal year 2014, CDC's Working Capital Fund has extended availability and serves as the funding mechanism
            to finance centralized business services support across CDC. Services rendered under the fund are performed at pre-established
            rates that are used to cover the full cost of operations and future investments. Contributions are collected for services,
            thereby creating market-like incentives to maximize efficiency and quality.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  148
                  148
                  148
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.5
                  Other personnel compensation
                  4
                  4
                  4
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  159
                  159
                  159
               
               
                  12.1
                  Civilian personnel benefits
                  50
                  50
                  50
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  22.0
                  Transportation of things
                  2
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  32
                  32
                  32
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  22
                  22
                  22
               
               
                  25.1
                  Advisory and assistance services
                  31
                  31
                  31
               
               
                  25.2
                  Other services from non-Federal sources
                  86
                  77
                  77
               
               
                  25.3
                  Other goods and services from Federal sources
                  76
                  68
                  68
               
               
                  25.4
                  Operation and maintenance of facilities
                  10
                  10
                  10
               
               
                  25.7
                  Operation and maintenance of equipment
                  57
                  57
                  57
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  12
                  12
                  12
               
               
                  32.0
                  Land and structures
                  8
                  8
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  549
                  532
                  532
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4553â0â4â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,276
                  1,276
                  1,276
               
               
                  2101
                  Reimbursable military average strength employment
                  22
                  22
                  22
               
               
                  
                     
                  
               
            
         
      
         Toxic substances and environmental public healthFor necessary expenses for the Agency for Toxic Substances and Disease Registry (ATSDR) in carrying out activities set forth
            in sections 104(i) and 111(c)(4) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (CERCLA)
            and section 3019 of the Solid Waste Disposal Act, $62,000,000: Provided, That notwithstanding any other provision of law, in lieu of performing a health assessment under section 104(i)(6) of CERCLA,
            the Administrator of ATSDR may conduct other appropriate health studies, evaluations, or activities, including, without limitation,
            biomedical testing, clinical evaluations, medical monitoring, and referral to accredited healthcare providers: Provided further, That in performing any such health assessment or health study, evaluation, or activity, the Administrator of ATSDR shall
            not be bound by the deadlines in section 104(i)(6)(A) of CERCLA: Provided further, That none of the funds appropriated under this heading shall be available for ATSDR to issue in excess of 40 toxicological
            profiles pursuant to section 104(i) of CERCLA during fiscal year 2019, and existing profiles may be updated as necessary.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â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)
                  â85
                  â95
                  â75
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  40
                  19
                  6
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5
                  â4
                  â4
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â4
                  â4
                  â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
                  â6
                  â3
                  â3
               
               
                  4033
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â7
                  â3
                  â3
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  75
                  74
                  62
               
               
                  4080
                  Outlays, net (discretionary)
                  75
                  92
                  72
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  3
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  75
                  74
                  62
               
               
                  4190
                  Outlays, net (total)
                  78
                  92
                  72
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  22
                  22
                  22
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  28
                  28
                  28
               
               
                  12.1
                  Civilian personnel benefits
                  8
                  8
                  8
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  8
                  8
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  5
                  5
                  3
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  9
                  4
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16
                  13
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  77
                  74
                  62
               
               
                  99.0
                  Reimbursable obligations
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  81
                  74
                  62
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0944â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  219
                  219
                  219
               
               
                  1101
                  Direct military average strength employment
                  36
                  36
                  36
               
               
                  
                     
                  
               
            
         
      
         World Trade Center Health Program Fund                                                                                   
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  World Trade Center Health ProgramâFederal Share (CDC/NIOSH)
                  351
                  420
                  469
               
               
                  0002
                  World Trade Center Health Programâ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 (WTCâNYC DHSSâ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)
                  â342
                  â345
                  â415
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â15
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â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. 111â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. 114â113, Division O, Title III). The amounts included for 2018 and 2019 in
            the Budget reflect estimated Federal obligations for the WTC Health Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  4
                  4
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  31
                  43
                  43
               
               
                  25.2
                  Other services from non-Federal sources
                  74
                  88
                  97
               
               
                  25.3
                  Other goods and services from Federal sources
                  10
                  12
                  12
               
               
                  41.0
                  Grants, subsidies, and contributions
                  20
                  24
                  24
               
               
                  42.0
                  Insurance claims and indemnities
                  249
                  289
                  339
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  390
                  462
                  521
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0946â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  16
                  16
                  16
               
               
                  1101
                  Direct military average strength employment
                  7
                  7
                  7
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         Federal Funds
         national cancer instituteFor carrying out section 301 and title IV of the PHS Act with respect to cancer, $3,756,093,000, of which up to $10,000,000 may be used for facilities repairs and improvements at the National Cancer InstituteâFrederick Federally Funded Research
            and Development Center in Frederick, Maryland.
      
         national heart, lung, and blood instituteFor carrying out section 301 and title IV of the PHS Act with respect to cardiovascular, lung, and blood diseases, and blood
            and blood products, $2,237,268,000.
      
         national institute of dental and craniofacial researchFor carrying out section 301 and title IV of the PHS Act with respect to dental and craniofacial diseases, $297,050,000.
      
         national institute of diabetes and digestive and kidney diseasesFor carrying out section 301 and title IV of the PHS Act with respect to diabetes and digestive and kidney disease, $1,305,132,000.
      
         national institute of neurological disorders and strokeFor carrying out section 301 and title IV of the PHS Act with respect to neurological disorders and stroke, $1,294,472,000.
      
         national institute of allergy and infectious diseasesFor carrying out section 301 and title IV of the PHS Act with respect to allergy and infectious diseases, $3,423,408,000.
      
         national institute of general medical sciencesFor carrying out section 301 and title IV of the PHS Act with respect to general medical sciences, $1,849,515,000, of which $741,000,000 shall be from funds available under section 241 of the PHS Act.
      
         eunice kennedy shriver national institute of child health and human developmentFor carrying out section 301 and title IV of the PHS Act with respect to child health and human development, $963,045,000.
      
         national eye instituteFor carrying out section 301 and title IV of the PHS Act with respect to eye diseases and visual disorders, $511,155,000.
      
         national institute of environmental health sciencesFor carrying out section 301 and title IV of the PHS Act with respect to environmental health sciences, $498,347,000.
      
         National institute of environmental health sciencesFor necessary expenses for the National Institute of Environmental Health Sciences in carrying out activities set forth in
            section 311(a) of the Comprehensive Environmental Response, Compensation, and Liability Act of 1980 (42 U.S.C. 9660(a)) and
            section 126(g) of the Superfund Amendments and Reauthorization Act of 1986, $53,967,000.
      
         national institute on agingFor carrying out section 301 and title IV of the PHS Act with respect to aging, $1,429,335,000.
      
         national institute of arthritis and musculoskeletal and skin diseasesFor carrying out section 301 and title IV of the PHS Act with respect to arthritis and musculoskeletal and skin diseases,
            $393,311,000.
      
         national institute on deafness and other communication disordersFor carrying out section 301 and title IV of the PHS Act with respect to deafness and other communication disorders, $304,812,000.
      
         national institute of nursing researchFor carrying out section 301 and title IV of the PHS Act with respect to nursing research, $104,847,000.
      
         national institute on alcohol abuse and alcoholismFor carrying out section 301 and title IV of the PHS Act with respect to alcohol abuse and alcoholism, $337,247,000
      
         national institute on drug abuseFor carrying out section 301 and title IV of the PHS Act with respect to drug abuse, $839,816,000.
      
         national institute of mental healthFor carrying out section 301 and title IV of the PHS Act with respect to mental health, $1,117,682,000.
      
         national human genome research instituteFor carrying out section 301 and title IV of the PHS Act with respect to human genome research, $368,785,000.
      
         national institute of biomedical imaging and bioengineeringFor carrying out section 301 and title IV of the PHS Act with respect to biomedical imaging and bioengineering research, $249,138,000.
      
         national center for complementary and integrative healthFor carrying out section 301 and title IV of the PHS Act with respect to complementary and integrative health, $93,974,000.
      
         national institute on minority health and health disparitiesFor carrying out section 301 and title IV of the PHS Act with respect to minority health and health disparities research,
            $201,686,000.
      
         john e. fogarty international centerFor carrying out the activities of the John E. Fogarty International Center (described in subpart 2 of part E of title IV
               of the PHS Act), $50,384,000.
      
         national library of medicineFor carrying out section 301 and title IV of the PHS Act with respect to health information communications, $284,324,000: Provided, That of the amounts available for improvement of information systems, $4,000,000 shall be available until September 30, 2020: Provided further, That in fiscal year 2019, the National Library of Medicine may enter into personal services contracts for the provision of services in facilities
            owned, operated, or constructed under the jurisdiction of the National Institutes of Health (referred to in this title as
            "NIH").
      
         national center for advancing translational sciencesFor carrying out section 301 and title IV of the PHS Act with respect to translational sciences, $492,515,000: Provided, That up to 10 percent of the amount available under this heading shall be available to implement section 480 of the PHS Act, relating to the Cures Acceleration Network.
      
         office of the directorFor carrying out the responsibilities of the Office of the Director, NIH, $1,338,005,000: Provided, That funding shall be available for the purchase of not to exceed 29 passenger motor vehicles for replacement only: Provided further, That all funds credited to the NIH Management Fund shall remain available for one fiscal year after the fiscal year in which
            they are deposited: Provided further, That $431,924,000 shall be available for the Common Fund established under section 402A(c)(1) of the PHS Act: Provided further, That of the funds provided, $10,000 shall be for official reception and representation expenses when specifically approved by the Director of the NIH: Provided further, That the Office of AIDS Research within the Office of the Director of the NIH may spend up to $8,000,000 to make grants for construction or renovation of facilities as provided for in section 2354(a)(5)(B) of the PHS Act.
      In addition to other funds appropriated for the Common Fund established under section 402A(c) of the PHS Act, $12,600,000 is appropriated to the Common Fund from the 10-year Pediatric Research Initiative Fund described in section 9008 of title
            26, United States Code, for the purpose of carrying out section 402(b)(7)(B)(ii) of the PHS Act (relating to pediatric research),
            as authorized in the Gabriella Miller Kids First Research Act.
      
         Buildings and facilitiesFor the study of, construction or demolition of, renovation of, and acquisition of equipment for, facilities of or used by
            NIH, including the acquisition of real property, $200,000,000, to remain available through September 30, 2023.
         National Institute for Research on Safety and QualityFor carrying out titles III and IX of the PHS Act, part A of title XI of the Social Security Act, and section 1013 of the
            Medicare Prescription Drug, Improvement, and Modernization Act of 2003, $255,960,000: Provided, That section 947(c) of the PHS Act shall not apply in fiscal year 2019: Provided further, That in addition, amounts received from Freedom of Information Act fees, reimbursable and interagency agreements, and the
            sale of data shall be credited to this appropriation and shall remain available until expended.
         National Institute for Occupational Safety and Health For carrying out titles II, III, and XVII of the PHS Act, sections 101, 102, 103, 201, 202, 203, 301, and 501 of the Federal
               Mine Safety and Health Act, section 13 of the Mine Improvement and New Emergency Response Act, and sections 20, 21, and 22
               of the Occupational Safety and Health Act, with respect to occupational safety and health, $200,000,000.
         Energy Employees Occupational Illness Compensation Program For necessary expenses to administer the Energy Employees Occupational Illness Compensation Program Act, $55,358,000, to remain
               available until expended: Provided, That this amount shall be available consistent with the provision regarding administrative
               expenses in section 151(b) of division B, title I of Public Law 106â554.
         National Institute on Disability, Independent Living, and Rehabilitation ResearchFor carrying out title II (and section 14 with respect to such title) of the Rehabilitation Act of 1973, $95,127,000.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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
                  â42
                  â42
                  â42
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â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 [075â0140]
                  66
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0943]
                  3
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â1700]
                  
                  
                  22
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â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 [075â1503]
                  â72
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5628]
                  300
                  298
                  515
               
               
                  1121
                  Appropriations transferred from other acct [075â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
                  â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
                  â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
                  â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)
                  â35,316
                  â37,879
                  â36,029
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â78
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â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
                  â1,207
                  â671
                  â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
                  â671
                  â671
                  â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
                  â3,950
                  â3,559
                  â3,559
               
               
                  4033
                  Non-Federal sources
                  â304
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,254
                  â3,559
                  â3,559
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  74
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  516
                  
                  
               
               
                  4053
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  591
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  33,214
                  33,047
                  24,333
               
               
                  4080
                  Outlays, net (discretionary)
                  30,899
                  34,160
                  32,374
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  182
                  80
                  42
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  22
                  51
                  42
               
               
                  4101
                  Outlays from mandatory balances
                  141
                  109
                  54
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  163
                  160
                  96
               
               
                  4180
                  Budget authority, net (total)
                  33,396
                  33,127
                  24,375
               
               
                  4190
                  Outlays, net (total)
                  31,062
                  34,320
                  32,470
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  33,396
                  33,127
                  24,375
               
               
                  
                  Outlays
                  31,062
                  34,320
                  32,470
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  113
                  150
               
               
                  
                  Outlays
                  
                  12
                  56
               
               
                  Total:
               
               
                  
                  Budget Authority
                  33,396
                  33,240
                  24,525
               
               
                  
                  Outlays
                  31,062
                  34,332
                  32,526
               
               
                  
                     
                  
               
            
         
      
      
         This program funds biomedical research and research training. These accounts will continue to be appropriated separately,
            and are displayed in a consolidated format to improve the readability of the presentation. The FY 2019 Budget consolidates
            the activities of the Agency for Healthcare Research and Quality within the National Institutes of Health as the National
            Institute for Research on Safety and Quality. It also consolidates the National Institute for Occupational Safety and Health
            (currently administered by the Centers for Disease Control and Prevention) and the National Institute on Disability, Independent
            Living, and Rehabilitation Research (currently administered by the Administration for Community Living) within the National
            Institutes of Health. Detailed information is available through the Department of Health and Human Services.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  976
                  1,007
                  1,181
               
               
                  11.3
                  Other than full-time permanent
                  520
                  529
                  535
               
               
                  11.5
                  Other personnel compensation
                  46
                  46
                  45
               
               
                  11.7
                  Military personnel
                  18
                  19
                  20
               
               
                  11.8
                  Special personal services payments
                  176
                  177
                  158
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  1,736
                  1,778
                  1,939
               
               
                  12.1
                  Civilian personnel benefits
                  506
                  518
                  536
               
               
                  12.2
                  Military personnel benefits
                  12
                  12
                  13
               
               
                  21.0
                  Travel and transportation of persons
                  51
                  51
                  22
               
               
                  22.0
                  Transportation of things
                  5
                  5
                  2
               
               
                  23.1
                  Rental payments to GSA
                  23
                  24
                  8
               
               
                  23.2
                  Rental payments to others
                  1
                  1
                  1
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  31
                  31
                  19
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  
               
               
                  25.1
                  Advisory and assistance services
                  231
                  200
                  100
               
               
                  25.2
                  Other services from non-Federal sources
                  1,445
                  1,189
                  614
               
               
                  25.3
                  Other goods and services from Federal sources
                  3,177
                  3,186
                  2,669
               
               
                  25.4
                  Operation and maintenance of facilities
                  201
                  208
                  368
               
               
                  25.5
                  Research and development contracts
                  1,534
                  1,402
                  1,012
               
               
                  25.6
                  Medical care
                  26
                  25
                  11
               
               
                  25.7
                  Operation and maintenance of equipment
                  122
                  121
                  51
               
               
                  25.8
                  Subsistence and support of persons
                  2
                  2
                  1
               
               
                  26.0
                  Supplies and materials
                  231
                  219
                  67
               
               
                  31.0
                  Equipment
                  154
                  147
                  50
               
               
                  41.0
                  Grants, subsidies, and contributions
                  24,057
                  23,623
                  16,558
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  33,546
                  32,743
                  24,041
               
               
                  99.0
                  Reimbursable obligations
                  4,021
                  4,440
                  3,592
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  37,567
                  37,183
                  27,633
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  13,251
                  13,314
                  14,571
               
               
                  1101
                  Direct military average strength employment
                  167
                  168
                  260
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  4,506
                  4,529
                  4,531
               
               
                  2101
                  Reimbursable military average strength employment
                  90
                  90
                  90
               
               
                  
                     
                  
               
            
         
      
         National Institutes of Health                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9915â4â1â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)
                  
                  â12
                  â56
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  101
                  195
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  101
               
               
                  3200
                  Obligated balance, end of year
                  
                  101
                  195
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  113
                  150
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  12
                  15
               
               
                  4101
                  Outlays from mandatory balances
                  
                  
                  41
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  12
                  56
               
               
                  4180
                  Budget authority, net (total)
                  
                  113
                  150
               
               
                  4190
                  Outlays, net (total)
                  
                  12
                  56
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to extend the Special Diabetes Program for Type 1 Diabetes through fiscal year 2019.
      
         Payment to the NIH Innovation Account, CURES Act                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0147â0â1â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)
                  â352
                  â496
                  â711
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  352
                  496
                  711
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  352
                  496
                  711
               
               
                  4180
                  Budget authority, net (total)
                  352
                  496
                  711
               
               
                  4190
                  Outlays, net (total)
                  352
                  496
                  711
               
               
                  
                     
                  
               
            
         
      
      
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         NIH Innovation, CURES Act For necessary expenses to carry out the purposes described in section 1001(b)(4) of the 21st Century Cures Act, in addition
            to amounts available for such purposes in the appropriations provided to the National Institutes of Health in this Act, $711,000,000, to remain available until expended: Provided, That such amounts are appropriated pursuant to section 1001(b)(3) of such Act and are to be derived from amounts transferred
            under section 1001(b)(2)(A) of such Act: Provided further, That of the amount appropriated under this heading, $400,000,000 shall be transferred to the "National Cancer Institute" for the purposes described in section 1001(b)(4)(C) of such Act,
            $57,500,000 shall be transferred to the "National Institute of Neurological Disorders and Stroke" for the purposes described in section
            1001(b)(4)(B) of such Act, and $57,500,000 shall be transferred to the "National Institute of Mental Health" for the purposes described in section 1001(b)(4)(B) of
            such Act: Provided further, That remaining amounts may be transferred by the Director of the National Institutes of Health to any accounts of the National
            Institutes of Health: Provided further, That upon a determination by the Director that funds transferred pursuant to any of the previous provisos are not necessary
            for the purposes provided, such amounts may be transferred back to this account: Provided further, That the transfer authority provided under this heading is in addition to any other transfer authority provided by law.
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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
                  â352
                  â350
                  â711
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  146
                  146
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5628â0â2â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 [075â9915]
                  â300
                  â298
                  â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)
                  
                  â37
                  â81
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  12
                  27
                  142
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  12
                  27
               
               
                  3200
                  Obligated balance, end of year
                  12
                  27
                  142
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  52
                  52
                  196
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  
                  12
                  47
               
               
                  4011
                  Outlays from discretionary balances
                  
                  25
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  
                  37
                  81
               
               
                  4180
                  Budget authority, net (total)
                  52
                  52
                  196
               
               
                  4190
                  Outlays, net (total)
                  
                  37
                  81
               
               
                  
                     
                  
               
            
         
      
      
         The Cures Act was enacted into law on December 13, 2016. The Cures Act authorizes $4.8 billion over 10 years for four NIH
            Innovation Projects, and includes amendments to the Public Health Service Act to advance Precision Medicine and other high
            priority NIH activities.
         
      
         10-Year Pediatric Research Initiative Fund                                                                               
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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
                  â13
                  â1
                  â13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  28
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5736â0â2â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 [075â9915]
                  â13
                  â1
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Substance Abuse and Mental Health Services Administration                                                                
            
         Federal Funds
         MENTAL HEALTHFor carrying out titles III, V, and XIX of the PHS Act with respect to mental health, and the Protection and Advocacy for
            Individuals with Mental Illness Act, $1,043,883,000: 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 113â93; 42 U.S.C. 290aa 22
            note).
      
         SUBSTANCE ABUSE TREATMENTFor carrying out titles III and V of the PHS Act with respect to substance abuse treatment and title XIX of such Act with
            respect to substance abuse treatment and prevention, $2,034,197,000: Provided, That in addition to amounts provided herein, $79,200,000 shall be available under section 241 of the PHS Act to supplement funds otherwise available for substance abuse treatment
            activities and to carry out subpart II of part B of title XIX of the PHS Act to fund section 1935(b) technical assistance,
            national data, data collection and evaluation activities, and further that the total available under this Act for section
            1935(b) activities shall not exceed 5 percent of the amounts appropriated for subpart II of part B of title XIX: Provided further, That none of the funds provided for section 1921 of the PHS Act shall be subject to section 241 of such Act.
      
         SUBSTANCE ABUSE PREVENTIONFor carrying out titles III and V of the PHS Act with respect to substance abuse prevention and for the Drug-Free Communities Support Program authorized by the Drug-Free Communities Act of 1997, as amended, $220,885,000, of which $2,000,000 shall be made available as directed by section 4 of Public Law 107â82, as amended by Public
               Law 109â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 114â198. 
      
         HEALTH SURVEILLANCE AND PROGRAM SUPPORTFor program support and cross-cutting activities that supplement activities funded under the headings "Mental Health", "Substance
            Abuse Treatment", and "Substance Abuse Prevention" in carrying out titles III, V, and XIX of the PHS Act, the Drug-Free Communities Act of 1997, as amended, and the Protection and Advocacy for Individuals with Mental Illness Act in the Substance Abuse and Mental Health Services
            Administration ("SAMHSA"), $126,922,000: Provided, That in addition to amounts provided herein, $20,426,000 shall be available under section 241 of the PHS Act to supplement funds available to carry out national surveys on drug abuse
            and mental health, to collect and analyze program data, and to conduct public awareness and technical assistance activities:
            Provided further, That, in addition, fees may be collected for the costs of publications, data, data tabulations, and data analysis completed
            under title V of the PHS Act and provided to a public or private entity upon request, which shall be credited to this appropriation
            and shall remain available until expended for such purposes: Provided further, That amounts made available in this Act for carrying out section 501(o) of the PHS Act shall remain available through September
            30, 2020: Provided further, That funds made available under this heading may be used to supplement program support funding provided under the headings
            "Mental Health", "Substance Abuse Treatment", and "Substance Abuse Prevention": Provided further, That the Assistant Secretary for Mental Health and Substance Use may transfer discretionary funds (pursuant to the Balanced
            Budget and Emergency Deficit Control Act of 1985) which are appropriated for the current fiscal year for SAMHSA in this Act
            between any of the accounts of SAMHSA with notification to the Committees on Appropriations of both Houses of Congress at
            least 15 days in advance of any transfer, but no such account shall be decreased by more than 3 percent by any such transfer.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â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 [075â1503]
                  â8
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â5627]
                  500
                  497
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0116]
                  
                  11
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  4,111
                  4,102
                  3,426
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  Appropriations transferred from the Prevention and Public Health Fund [075â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)
                  â3,759
                  â4,047
                  â3,753
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â95
                  â326
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,506
                  4,476
                  4,289
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â245
                  â143
                  â224
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â91
                  â81
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  193
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â143
                  â224
                  â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
                  â344
                  â311
                  â135
               
               
                  4033
                  Non-Federal sources
                  â1
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â345
                  â313
                  â137
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â91
                  â81
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  192
                  153
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  101
                  72
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  4,111
                  4,102
                  3,426
               
               
                  4080
                  Outlays, net (discretionary)
                  3,378
                  3,726
                  3,615
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  12
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  36
                  8
                  1
               
               
                  4180
                  Budget authority, net (total)
                  4,123
                  4,102
                  3,426
               
               
                  4190
                  Outlays, net (total)
                  3,414
                  3,734
                  3,616
               
               
                  
                     
                  
               
            
         
      
      
         This program provides Federal support to strengthen the capacity of the Nation's health care delivery system to provide effective
            substance abuse prevention, addiction treatment, and mental health services for people at risk for or experiencing substance
            abuse or mental illness. SAMHSA builds partnerships with States, communities, tribal organizations, and private not-for-profit
            organizations to enhance health and reduce the adverse impact of substance abuse and mental illness on America's communities.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  46
                  50
                  52
               
               
                  11.3
                  Other than full-time permanent
                  2
                  3
                  3
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  11.7
                  Military personnel
                  3
                  4
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  52
                  58
                  60
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  17
                  18
               
               
                  12.2
                  Military personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  23.1
                  Rental payments to GSA
                  7
                  7
                  7
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  29
                  31
                  31
               
               
                  25.2
                  Other services from non-Federal sources
                  191
                  179
                  196
               
               
                  25.3
                  Other goods and services from Federal sources
                  45
                  47
                  48
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,775
                  3,755
                  3,058
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  4,123
                  4,102
                  3,426
               
               
                  99.0
                  Reimbursable obligations
                  242
                  241
                  140
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,365
                  4,343
                  3,566
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1362â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  451
                  475
                  475
               
               
                  1101
                  Direct military average strength employment
                  31
                  31
                  31
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  101
                  101
                  71
               
               
                  2101
                  Reimbursable military average strength employment
                  7
                  7
                  7
               
               
                  
                     
                  
               
            
         
      
         Agency for Healthcare Research and Quality                                                                               
            
         Federal Funds
         Healthcare research and quality
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â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 [075â9915]
                  
                  
                  â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 [075â1503]
                  â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)
                  â365
                  â308
                  â240
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  345
                  377
                  137
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â85
                  â53
                  â61
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â15
                  â8
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  47
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â53
                  â61
                  â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
                  â40
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â40
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â15
                  â8
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  24
                  â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
                  â7
                  â8
                  
               
               
                  4180
                  Budget authority, net (total)
                  323
                  322
                  
               
               
                  4190
                  Outlays, net (total)
                  318
                  300
                  240
               
               
                  
                     
                  
               
            
         
      
      
         The FY 2019 Budget consolidates the activities of the Agency for Healthcare Research and Quality within the National Institutes
            of Health as the National Institute for Research on Safety and Quality.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  30
                  33
                  
               
               
                  11.3
                  Other than full-time permanent
                  4
                  3
                  
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  
               
               
                  11.7
                  Military personnel
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  36
                  38
                  
               
               
                  12.1
                  Civilian personnel benefits
                  11
                  10
                  
               
               
                  12.2
                  Military personnel benefits
                  
                  1
                  
               
               
                  23.1
                  Rental payments to GSA
                  3
                  4
                  
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  1
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  15
                  
               
               
                  25.3
                  Other goods and services from Federal sources
                  22
                  19
                  
               
               
                  25.5
                  Research and development contracts
                  134
                  130
                  
               
               
                  31.0
                  Equipment
                  1
                  2
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  104
                  102
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  323
                  322
                  
               
               
                  99.0
                  Reimbursable obligations
                  18
                  18
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  341
                  340
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1700â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  273
                  270
                  
               
               
                  1101
                  Direct military average strength employment
                  7
                  7
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  2
                  2
                  
               
               
                  3001
                  Allocation account civilian full-time equivalent employment
                  8
                  8
                  
               
               
                  
                     
                  
               
            
         
      
         Centers for Medicare and Medicaid Services                                                                               
            
         Federal Funds
         Grants to states for medicaidFor carrying out, except as otherwise provided, titles XI and XIX of the Social Security Act, $276,236,212,000, to remain available until expended.
      In addition, for carrying out such titles after May 31, 2019, for the last quarter of fiscal year 2019 for unanticipated costs incurred for the current fiscal year, such sums as may be necessary, to remain available until expended.
      In addition, for carrying out such titles for the first quarter of fiscal year 2020, $137,931,797,000, to remain available until expended.
      Payment under such title XIX may be made for any quarter with respect to a State plan or plan amendment in effect during such
            quarter, if submitted in or prior to such quarter and approved in that or any subsequent quarter.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  394,370
                  407,290
                  433,103
               
               
                  0002
                  State and local administration
                  22,596
                  20,960
                  21,475
               
               
                  0003
                  Vaccines for Children
                  4,427
                  4,401
                  4,726
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  421,393
                  432,651
                  459,304
               
               
                  0801
                  Medicare Part B premiums
                  652
                  1,000
                  1,054
               
               
                  0802
                  Medicare Part D
                  
                  3
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  652
                  1,003
                  1,058
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  422,045
                  433,654
                  460,362
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  413
                  309
                  11,545
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  34,566
                  33,870
                  36,675
               
               
                  1029
                  Other balances withdrawn to Treasury
                  â15,728
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  12,812
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  32,063
                  34,179
                  48,220
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  273,767
                  284,798
                  276,236
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  115,583
                  125,219
                  134,848
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  652
                  1,003
                  1,058
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  289
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total):
                  941
                  1,003
                  1,058
               
               
                  1900
                  Budget authority (total)
                  390,291
                  411,020
                  412,142
               
               
                  1930
                  Total budgetary resources available
                  422,354
                  445,199
                  460,362
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  309
                  11,545
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  40,649
                  39,982
                  36,675
               
               
                  3010
                  New obligations, unexpired accounts
                  422,045
                  433,654
                  460,362
               
               
                  3020
                  Outlays (gross)
                  â388,146
                  â403,091
                  â421,300
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â34,566
                  â33,870
                  â36,675
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  39,982
                  36,675
                  39,062
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â105
                  â394
                  â394
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â289
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â394
                  â394
                  â394
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  40,544
                  39,588
                  36,281
               
               
                  3200
                  Obligated balance, end of year
                  39,588
                  36,281
                  38,668
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  390,291
                  411,020
                  412,142
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  356,275
                  363,110
                  412,142
               
               
                  4101
                  Outlays from mandatory balances
                  31,871
                  39,981
                  9,158
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  388,146
                  403,091
                  421,300
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â652
                  â1,003
                  â1,058
               
               
                  4123
                  Non-Federal sources
                  â12,812
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â13,464
                  â1,003
                  â1,058
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â289
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  12,812
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  12,523
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  389,350
                  410,017
                  411,084
               
               
                  4170
                  Outlays, net (mandatory)
                  374,682
                  402,088
                  420,242
               
               
                  4180
                  Budget authority, net (total)
                  389,350
                  410,017
                  411,084
               
               
                  4190
                  Outlays, net (total)
                  374,682
                  402,088
                  420,242
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  389,350
                  410,017
                  411,084
               
               
                  
                  Outlays
                  374,682
                  402,088
                  420,242
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  â1,700
                  â8,209
               
               
                  
                  Outlays
                  
                  â1,700
                  â8,209
               
               
                  Total:
               
               
                  
                  Budget Authority
                  389,350
                  408,317
                  402,875
               
               
                  
                  Outlays
                  374,682
                  400,388
                  412,033
               
               
                  
                     
                  
               
            
         
      
      
         Medicaid assists States in providing medical care to their low-income populations by granting Federal matching payments under
            title XIX of the Social Security Act to States with approved plans.
         
         Medicaid estimates assume budget authority for expenses that are incurred but not reported (IBNR).
         Authorized as part of title XIX, Vaccines for Children (VFC) finances the purchase of vaccines for low-income, eligible children.
            VFC is administered by the Centers for Disease Control and Prevention and is funded entirely by the Federal Government.
         
         Vaccines for Children  (in millions of dollars)
         
            
               
                  
                     
                        
                     
                  
                  
                     Obligations
                     2017
                     2018
                     2019
                  
                  
                     
                        
                     
                  
                  
                     Vaccine Purchase
                     4,241
                     4,193
                     4,427
                  
                  
                     Vaccine Stockpile
                     14
                     27
                     112
                  
                  
                     Ordering, Distribution, and Operations
                     133
                     130
                     136
                  
                  
                     Vaccine Management Contract Support
                     0
                     0
                     0
                  
                  
                     Evaluation Activities
                     50
                     51
                     52
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Obligations
                     4,437
                     4,401
                     4,726
                  
                  
                     
                        
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  421,393
                  432,651
                  459,304
               
               
                  99.0
                  Reimbursable obligations
                  652
                  1,003
                  1,058
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  422,045
                  433,654
                  460,362
               
               
                  
                     
                  
               
            
         
      
         Grants to States for Medicaid                                                                                            
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0512â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicaid Vendor Payments
                  
                  â1,700
                  â8,209
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  â1,700
                  â8,209
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  â1,700
                  â8,209
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  â1,700
                  â8,209
               
               
                  1900
                  Budget authority (total)
                  
                  â1,700
                  â8,209
               
               
                  1930
                  Total budgetary resources available
                  
                  â1,700
                  â8,209
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  â1,700
                  â8,209
               
               
                  3020
                  Outlays (gross)
                  
                  1,700
                  8,209
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â1,700
                  â8,209
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â1,700
                  â8,209
               
               
                  4180
                  Budget authority, net (total)
                  
                  â1,700
                  â8,209
               
               
                  4190
                  Outlays, net (total)
                  
                  â1,700
                  â8,209
               
               
                  
                     
                  
               
            
         
      
      
         This schedule reflects the Administration's Medicaid proposals.
      
         State Grants and Demonstrations                                                                                          
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0011
                  Emergency health services for undocumented aliens
                  1
                  
                  
               
               
                  0012
                  Medicaid integrity program
                  92
                  86
                  87
               
               
                  0023
                  Grants to improve outreach and enrollment
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  111
                  86
                  87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  111
                  86
                  87
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1,006
                  244
                  238
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  32
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,039
                  244
                  238
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  84
                  86
                  87
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â6
                  â6
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â760
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  â682
                  80
                  87
               
               
                  1900
                  Budget authority (total)
                  â682
                  80
                  87
               
               
                  1930
                  Total budgetary resources available
                  357
                  324
                  325
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â2
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  244
                  238
                  238
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,721
                  1,297
                  800
               
               
                  3010
                  New obligations, unexpired accounts
                  111
                  86
                  87
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  4
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â503
                  â583
                  â578
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â32
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,297
                  800
                  309
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,721
                  1,297
                  800
               
               
                  3200
                  Obligated balance, end of year
                  1,297
                  800
                  309
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  â682
                  80
                  87
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  7
                  6
                  14
               
               
                  4101
                  Outlays from mandatory balances
                  496
                  577
                  564
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  503
                  583
                  578
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  â682
                  80
                  87
               
               
                  4170
                  Outlays, net (mandatory)
                  502
                  583
                  578
               
               
                  4180
                  Budget authority, net (total)
                  â682
                  80
                  87
               
               
                  4190
                  Outlays, net (total)
                  502
                  583
                  578
               
               
                  
                     
                  
               
            
         
      
      
         State Grants and Demonstrations includes funding for grant programs enacted in several legislative authorities, including
            the Ticket to Work and Work Incentives Improvement Act of 1999 (P.L. 106â170), the Medicare Prescription Drug, Improvement,
            and Modernization Act of 2003 (P.L. 108â173), the Deficit Reduction Act of 2005 (P.L. 109â171), the Children's Health Insurance
            Program Reauthorization Act of 2009 (P.L. 111â3), the Patient Protection and Affordable Care Act (P.L. 111â148), the Health
            Care and Education Reconciliation Act of 2010 (P.L. 111â152), the Protecting Access to Medicare Act of 2014 (P.L. 113â93),
            and the Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent - Medicaid Integrity Program
                  10
                  12
                  12
               
               
                  12.1
                  Civilian personnel benefits - Medicaid Integrity Program
                  5
                  6
                  6
               
               
                  41.0
                  Grants, subsidies, and contributions - Emergency services for undocumented aliens
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions - Medicaid Integrity Program
                  77
                  68
                  69
               
               
                  41.0
                  Grants, subsidies, and contributions - Grants to improve outreach and enrollment
                  18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  111
                  86
                  87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  111
                  86
                  87
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0516â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  91
                  207
                  207
               
               
                  
                     
                  
               
            
         
      
         Payments to health care trust fundsFor payment to the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, as provided
            under sections 217(g), 1844, and 1860D-16 of the Social Security Act, sections 103(c) and 111(d) of the Social Security Amendments
            of 1965, section 278(d)(3) of Public Law 97â248, and for administrative expenses incurred pursuant to section 201(g) of the
            Social Security Act, $378,343,800,000.
      In addition, for making matching payments under section 1844 and benefit payments under section 1860D-16 of the Social Security
            Act that were not anticipated in budget estimates, such sums as may be necessary.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  229,733
                  262,496
                  284,288
               
               
                  0002
                  Part D benefits (Rx Drug)
                  82,382
                  88,133
                  92,070
               
               
                  0003
                  Part D Federal administration (Rx Drug)
                  405
                  422
                  642
               
               
                  0004
                  General Fund Transfers to HI
                  1,293
                  1,543
                  1,339
               
               
                  0006
                  Federal Bureau of Investigation (HCFAC)
                  131
                  135
                  147
               
               
                  0007
                  Federal payments from taxation of OASDI benefits (HI)
                  24,206
                  23,684
                  24,943
               
               
                  0008
                  Criminal fines (HCFAC)
                  12
                  109
                  150
               
               
                  0009
                  Civil penalties and damages (HCFACâDOJ and CMS administration)
                  46
                  51
                  52
               
               
                  0010
                  Asset Forfeiture
                  25
                  30
                  31
               
               
                  0011
                  State Low Income Determinations
                  3
                  3
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  338,236
                  376,606
                  403,666
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  1,928
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  313,816
                  352,597
                  378,323
               
               
                  1200
                  Appropriation (indefinite, permanent)
                  24,206
                  25,612
                  29,065
               
               
                  1200
                  Appropriation (HCFAC for FBI)
                  131
                  135
                  147
               
               
                  1200
                  Appropriation (indefinite for HCFAC)
                  83
                  190
                  254
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  338,236
                  378,534
                  407,789
               
               
                  1930
                  Total budgetary resources available
                  338,236
                  378,534
                  409,717
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  1,928
                  6,051
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  27,070
                  18,743
                  52,991
               
               
                  3010
                  New obligations, unexpired accounts
                  338,236
                  376,606
                  403,666
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1,306
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â335,137
                  â342,358
                  â364,182
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â12,732
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  18,743
                  52,991
                  92,475
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  27,070
                  18,743
                  52,991
               
               
                  3200
                  Obligated balance, end of year
                  18,743
                  52,991
                  92,475
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  338,236
                  378,534
                  407,789
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  324,303
                  324,552
                  336,360
               
               
                  4101
                  Outlays from mandatory balances
                  10,834
                  17,806
                  27,822
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  335,137
                  342,358
                  364,182
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â931
                  
                  
               
               
                  4123
                  Non-Federal sources
                  â1,306
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â2,237
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  2,237
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  338,236
                  378,534
                  407,789
               
               
                  4170
                  Outlays, net (mandatory)
                  332,900
                  342,358
                  364,182
               
               
                  4180
                  Budget authority, net (total)
                  338,236
                  378,534
                  407,789
               
               
                  4190
                  Outlays, net (total)
                  332,900
                  342,358
                  364,182
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  338,236
                  378,534
                  407,789
               
               
                  
                  Outlays
                  332,900
                  342,358
                  364,182
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  â39
                  â2,328
               
               
                  
                  Outlays
                  
                  â39
                  â2,328
               
               
                  Total:
               
               
                  
                  Budget Authority
                  338,236
                  378,495
                  405,461
               
               
                  
                  Outlays
                  332,900
                  342,319
                  361,854
               
               
                  
                     
                  
               
            
         
      
      
         Payments are made to the Federal Hospital Insurance and Federal Supplementary Medical Insurance trust funds from the general
            fund of the Treasury to finance Medicare's medical and drug benefits for beneficiaries, and administrative expenses that are
            properly chargeable to the general fund.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â0â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions
                  336,507
                  374,641
                  401,684
               
               
                  42.0
                  Insurance claims and indemnities (HI Uninsured Federal)
                  147
                  132
                  127
               
               
                  94.0
                  Financial transfers (Federal admin)
                  1,582
                  1,833
                  1,855
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  338,236
                  376,606
                  403,666
               
               
                  
                     
                  
               
            
         
      
         Payments to Health Care Trust Funds                                                                                      
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0580â2â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Federal contribution to match premiums (SMI)
                  
                  
                  â2,484
               
               
                  0002
                  Part D benefits (Rx Drug)
                  
                  â39
                  156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  â39
                  â2,328
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (definite, annual)
                  
                  â39
                  â2,328
               
               
                  1930
                  Total budgetary resources available
                  
                  â39
                  â2,328
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  â39
                  â2,328
               
               
                  3020
                  Outlays (gross)
                  
                  39
                  2,328
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â39
                  â2,328
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â39
                  â2,328
               
               
                  4180
                  Budget authority, net (total)
                  
                  â39
                  â2,328
               
               
                  4190
                  Outlays, net (total)
                  
                  â39
                  â2,328
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Quality Improvement Organizations                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  QIO contracts
                  397
                  603
                  1,297
               
               
                  0002
                  QIO support contracts
                  180
                  171
                  155
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  577
                  774
                  1,452
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  124
                  774
                  1,452
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  491
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  615
                  774
                  1,452
               
               
                  1930
                  Total budgetary resources available
                  615
                  774
                  1,452
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â38
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,519
                  1,187
                  1,187
               
               
                  3010
                  New obligations, unexpired accounts
                  577
                  774
                  1,452
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â883
                  â774
                  â1,452
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,187
                  1,187
                  1,187
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â2,488
                  â1,983
                  â1,983
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â491
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  996
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1,983
                  â1,983
                  â1,983
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â969
                  â796
                  â796
               
               
                  3200
                  Obligated balance, end of year
                  â796
                  â796
                  â796
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  615
                  774
                  1,452
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  137
                  118
                  972
               
               
                  4101
                  Outlays from mandatory balances
                  746
                  656
                  480
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  883
                  774
                  1,452
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â957
                  â774
                  â1,452
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â491
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  833
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  342
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â74
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â74
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  50
                  50
                  50
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  50
                  50
                  50
               
               
                  
                     
                  
               
            
         
      
      
         Part B of title XI of the Social Security Act, as amended by the Peer Review Improvement Act of 1982, provides the statutory
            authority for the Medicare Quality Improvement Organization (QIO) Program. The mission of the program is to promote the effectiveness,
            efficiency, economy, and quality of services delivered to Medicare beneficiaries and to ensure that those services are reasonable
            and necessary. The program is funded through transfers from the Medicare Hospital Insurance Trust Fund and the Medicare Supplementary
            Medical Insurance Trust Fund. In FY 2012, a Treasury account specific to the QIO program was established to improve budgetary
            operations.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  34
                  34
                  34
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  3
               
               
                  25.2
                  Other services from non-Federal sources
                  511
                  699
                  1,336
               
               
                  25.3
                  Other goods and services from Federal sources
                  20
                  26
                  51
               
               
                  25.4
                  Operation and maintenance of facilities
                  11
                  14
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  577
                  774
                  1,452
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0519â0â1â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  229
                  232
                  232
               
               
                  
                     
                  
               
            
         
      
         Program managementFor carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and
            XXVII of the PHS Act, the Clinical Laboratory Improvement Amendments of 1988, and other responsibilities of the Centers for
            Medicare and Medicaid Services, not to exceed $3,343,879,000, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
            as authorized by section 201(g) of the Social Security Act; together with all funds collected in accordance with section 353
            of the PHS Act and section 1857(e)(2) of the Social Security Act, funds retained by the Secretary pursuant to section 1893(h)
            of the Social Security Act, and such sums as may be collected from authorized user fees and the sale of data, which shall
            be credited to this account and remain available until expended: Provided, That all funds derived in accordance with 31 U.S.C. 9701 from organizations established under title XIII of the PHS Act shall
            be credited to and available for carrying out the purposes of this appropriation: Provided further, That the Secretary is directed to collect fees in fiscal year 2019 from Medicare Advantage organizations pursuant to section 1857(e)(2) of the Social Security Act and from eligible organizations
            with risk-sharing contracts under section 1876 of that Act pursuant to section 1876(k)(4)(D) of that Act.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  3,094
                  3,172
                  2,422
               
               
                  0002
                  Federal administration
                  762
                  775
                  733
               
               
                  0003
                  State survey and certification
                  409
                  425
                  444
               
               
                  0004
                  Research, demonstrations, and evaluation projects
                  58
                  85
                  29
               
               
                  0007
                  ARRA Medicare/Medicaid HIT
                  56
                  123
                  23
               
               
                  0008
                  Risk Corridor
                  3,953
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  8,332
                  4,580
                  3,651
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  8,332
                  4,580
                  3,651
               
               
                  0801
                  Clinical laboratory improvement amendments
                  50
                  47
                  50
               
               
                  0802
                  Sale of data
                  12
                  20
                  20
               
               
                  0803
                  Coordination of benefits
                  34
                  28
                  30
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  80
                  81
                  83
               
               
                  0805
                  Provider enrollment
                  18
                  24
                  24
               
               
                  0806
                  Recovery audit contractors
                  89
                  285
                  572
               
               
                  0808
                  Marketplace User Fees
                  1,126
                  1,212
                  962
               
               
                  0810
                  Risk Adjustment Administrative Expenses
                  22
                  19
                  38
               
               
                  0813
                  Other reimbursable program activity
                  209
                  15
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  1,640
                  1,731
                  1,795
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  9,972
                  6,311
                  5,446
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  â5,575
                  â9,239
                  1,871
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â500
                  â129
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  97
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  â5,970
                  â9,368
                  1,871
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3
                  12,303
                  3
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  â812
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  3
                  11,491
                  3
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,973
                  3,993
                  3,378
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2,372
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  4,345
                  3,993
                  3,378
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1,931
                  2,041
                  1,919
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  386
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  86
                  25
                  103
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  2,395
                  2,066
                  2,022
               
               
                  1900
                  Budget authority (total)
                  6,743
                  17,550
                  5,403
               
               
                  1930
                  Total budgetary resources available
                  773
                  8,182
                  7,274
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â40
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  â9,239
                  1,871
                  1,828
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  12,072
                  16,607
                  4,895
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  536
                  25
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  9,972
                  6,311
                  5,446
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  421
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â6,066
                  â18,048
                  â5,683
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â97
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â231
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  16,607
                  4,895
                  4,658
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â5,470
                  â6,083
                  â6,083
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,758
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  2,145
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6,083
                  â6,083
                  â6,083
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7,138
                  10,549
                  â1,188
               
               
                  3200
                  Obligated balance, end of year
                  10,524
                  â1,188
                  â1,425
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  4,345
                  3,993
                  3,378
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,906
                  3,993
                  3,378
               
               
                  4011
                  Outlays from discretionary balances
                  2,388
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,294
                  3,993
                  3,378
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â4,161
                  â3,973
                  â3,344
               
               
                  4033
                  Non-Federal sources
                  â126
                  â20
                  â34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â4,287
                  â3,993
                  â3,378
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2,372
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  2,314
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â58
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  7
                  
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,398
                  13,557
                  2,025
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  548
                  2,115
                  1,953
               
               
                  4101
                  Outlays from mandatory balances
                  1,224
                  11,940
                  352
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,772
                  14,055
                  2,305
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â343
                  â189
                  â145
               
               
                  4123
                  Non-Federal sources
                  â1,596
                  â1,852
                  â1,774
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â1,939
                  â2,041
                  â1,919
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â386
                  
                  
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  8
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â378
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  81
                  11,516
                  106
               
               
                  4170
                  Outlays, net (mandatory)
                  â167
                  12,014
                  386
               
               
                  4180
                  Budget authority, net (total)
                  81
                  11,516
                  106
               
               
                  4190
                  Outlays, net (total)
                  â160
                  12,014
                  386
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  207
                  128
                  103
               
               
                  5091
                  Expiring unavailable balance: Offsetting collections
                  â1
                  
                  
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  128
                  103
                  
               
               
                  5093
                  Expired unavailable balance, SOY: Offsetting collections
                  1
                  2
                  2
               
               
                  5095
                  Expired unavailable balance, EOY: Offsetting collections
                  1
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  81
                  11,516
                  106
               
               
                  
                  Outlays
                  â160
                  12,014
                  386
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  812
                  12
               
               
                  
                  Outlays
                  
                  812
                  12
               
               
                  Total:
               
               
                  
                  Budget Authority
                  81
                  12,328
                  118
               
               
                  
                  Outlays
                  â160
                  12,826
                  398
               
               
                  
                     
                  
               
            
         
      
      
         Program management activities include funding for program operations, survey and certification, the Clinical Laboratory Improvement
            Amendments (CLIA), Medicare Advantage, Medicare Part D coordination of benefits, recovery audit contracts and other administrative
            costs. The 2019 Budget includes mandatory resources for the Risk Corridor Program.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  466
                  483
                  450
               
               
                  11.3
                  Other than full-time permanent
                  12
                  11
                  11
               
               
                  11.5
                  Other personnel compensation
                  7
                  8
                  8
               
               
                  11.7
                  Military personnel
                  17
                  14
                  14
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  502
                  516
                  483
               
               
                  12.1
                  Civilian personnel benefits
                  158
                  153
                  149
               
               
                  12.2
                  Military personnel benefits
                  9
                  7
                  7
               
               
                  23.1
                  Rental payments to GSA
                  11
                  
                  
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  48
                  
                  
               
               
                  24.0
                  Printing and reproduction
                  60
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  3,121
                  3,904
                  3,012
               
               
                  25.3
                  Other goods and services from Federal sources
                  77
                  
                  
               
               
                  25.6
                  Medical care
                  380
                  
                  
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  12
                  
                  
               
               
                  42.0
                  Insurance claims and indemnities
                  3,953
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  8,332
                  4,580
                  3,651
               
               
                  99.0
                  Reimbursable obligations
                  1,640
                  1,731
                  1,795
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  9,972
                  6,311
                  5,446
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â0â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4,376
                  4,365
                  4,099
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  159
                  157
                  157
               
               
                  1101
                  Direct military average strength employment
                  138
                  138
                  138
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  240
                  249
                  249
               
               
                  
                     
                  
               
            
         
      
         Program Management                                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Program operations
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Total direct program
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  12
               
               
                  0801
                  ACL SHIPs
                  
                  13
                  13
               
               
                  0804
                  Medicare advantage/Prescription drug plan
                  
                  
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  13
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  13
                  55
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  812
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  12
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  
                  812
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  812
                  12
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  13
                  43
               
               
                  1900
                  Budget authority (total)
                  
                  825
                  55
               
               
                  1930
                  Total budgetary resources available
                  
                  825
                  867
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  812
                  812
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  â812
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  13
                  55
               
               
                  3020
                  Outlays (gross)
                  
                  â825
                  â55
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  â812
                  â812
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  â812
               
               
                  3200
                  Obligated balance, end of year
                  
                  â812
                  â812
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  825
                  55
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  13
                  55
               
               
                  4101
                  Outlays from mandatory balances
                  
                  812
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  
                  825
                  55
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  â13
                  â13
               
               
                  4123
                  Non-Federal sources
                  
                  
                  â30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  
                  â13
                  â43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  
                  812
                  12
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  812
                  12
               
               
                  4180
                  Budget authority, net (total)
                  
                  812
                  12
               
               
                  4190
                  Outlays, net (total)
                  
                  812
                  12
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0511â4â1â550
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  25.3
                  Direct obligations: Other goods and services from Federal sources
                  
                  
                  12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  12
               
               
                  99.0
                  Reimbursable obligations
                  
                  13
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  13
                  55
               
               
                  
                     
                  
               
            
         
      
         Payments to Hospitals                                                                                                    
            
         
         Payments to Hospitals                                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0514â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to hospitals
                  
                  
                  14,540
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  14,540
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  14,540
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  14,540
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  14,540
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â14,540
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  14,540
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  14,540
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  14,540
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  14,540
               
               
                  
                     
                  
               
            
         
      
      
         This account reflects the Budget's proposals to modify payments to hospitals for uncompensated care and consolidate graduate
            medical education spending.  
         
      
         Children's Health Insurance Fund                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to states and US territories
                  15,952
                  5,700
                  5,700
               
               
                  0002
                  CHIP Redistribution Funds
                  8
                  3,052
                  
               
               
                  0003
                  Child health quality
                  6
                  20
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  15,966
                  8,772
                  5,724
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3,013
                  6,441
                  2,747
               
               
                  1011
                  Unobligated balance transfer from other acct [075â5551]
                  3,656
                  
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  704
                  101
                  
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  
                  â170
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  2,188
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7,381
                  8,560
                  2,747
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310
                  
                  â2,652
                  
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced, Perf. Bonus Pmts.
                  
                  â89
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total):
                  
                  â2,741
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  20,400
                  5,700
                  5,700
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  2,050
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â7,424
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  15,026
                  5,700
                  5,700
               
               
                  1900
                  Budget authority (total)
                  15,026
                  2,959
                  5,700
               
               
                  1930
                  Total budgetary resources available
                  22,407
                  11,519
                  8,447
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6,441
                  2,747
                  2,723
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  8,070
                  7,804
                  1,768
               
               
                  3010
                  New obligations, unexpired accounts
                  15,966
                  8,772
                  5,724
               
               
                  3020
                  Outlays (gross)
                  â16,224
                  â12,620
                  â5,724
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  â2,188
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,804
                  1,768
                  1,768
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  8,070
                  7,804
                  1,768
               
               
                  3200
                  Obligated balance, end of year
                  7,804
                  1,768
                  1,768
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  â2,741
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  15,026
                  5,700
                  5,700
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  8,826
                  5,700
                  5,700
               
               
                  4101
                  Outlays from mandatory balances
                  7,398
                  6,920
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  16,224
                  12,620
                  5,724
               
               
                  4180
                  Budget authority, net (total)
                  15,026
                  2,959
                  5,700
               
               
                  4190
                  Outlays, net (total)
                  16,224
                  12,620
                  5,724
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  15,026
                  2,959
                  5,700
               
               
                  
                  Outlays
                  16,224
                  12,620
                  5,724
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â3,118
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  5,643
                  9,172
               
               
                  
                  Outlays
                  
                  4,500
                  5,700
               
               
                  Total:
               
               
                  
                  Budget Authority
                  15,026
                  8,602
                  11,754
               
               
                  
                  Outlays
                  16,224
                  17,120
                  11,424
               
               
                  
                     
                  
               
            
         
      
      
         The Balanced Budget Act of 1997 established the Children's Health Insurance Program (CHIP) under title XXI of the Social Security
            Act. Title XXI provides Federal matching funds to States to enable them to extend coverage to uninsured children from low-income
            families. States are able to use title XXI funds for obtaining health benefit coverage for uninsured children through a separate
            CHIP program, a CHIP Medicaid expansion program, or a combination of both. The Children's Health Insurance Program Reauthorization
            Act of 2009 (P.L. 111â3, CHIPRA) reauthorized the CHIP program and appropriated funding for CHIP through fiscal year 2013.
            CHIPRA made some modifications to the program, including increased funding for States and territories, bonus payments for
            States that exceed Medicaid child enrollment targets, and support for child health quality and outreach activities. A contingency
            fund to assist States who project spending above their available allocated CHIP funds was also created by CHIPRA and funding
            is included in a separate account. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) extended funding
            for CHIP, providing appropriations through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L.
            114â10) extended CHIP funding through fiscal year 2017, and the Further Additional Continuing Appropriations Act of 2018 (P.L.
            115â96) provided partial year funding for FY 2018. 
         
      
         Children's Health Insurance Fund                                                                                         
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â2â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced, Sec. 108/MACRA Sec. 310
                  
                  
                  â3,118
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â3,118
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â3,118
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â3,118
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â3,118
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â3,118
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Children's Health Insurance Fund                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0515â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  5,643
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  4,500
                  5,700
               
               
                  1221
                  Appropriations transferred from other acct [075â5551]
                  
                  1,143
                  3,472
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  5,643
                  9,172
               
               
                  1930
                  Total budgetary resources available
                  
                  5,643
                  14,815
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  5,643
                  14,815
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  
                  
                  â4,500
               
               
                  3020
                  Outlays (gross)
                  
                  â4,500
                  â5,700
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  â4,500
                  â10,200
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  
                  
                  â4,500
               
               
                  3200
                  Obligated balance, end of year
                  
                  â4,500
                  â10,200
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  5,643
                  9,172
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  4,500
                  5,700
               
               
                  4180
                  Budget authority, net (total)
                  
                  5,643
                  9,172
               
               
                  4190
                  Outlays, net (total)
                  
                  4,500
                  5,700
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to extend CHIP funding through fiscal year 2019 with reforms.
      
         Center for Medicare and Medicaid Innovation                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Administration
                  302
                  395
                  342
               
               
                  0002
                  Innovation Activities
                  699
                  1,383
                  1,363
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,001
                  1,778
                  1,705
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  4,404
                  3,484
                  1,706
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  81
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4,485
                  3,484
                  1,706
               
               
                  1930
                  Total budgetary resources available
                  4,485
                  3,484
                  1,706
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3,484
                  1,706
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,592
                  1,376
                  1,876
               
               
                  3010
                  New obligations, unexpired accounts
                  1,001
                  1,778
                  1,705
               
               
                  3020
                  Outlays (gross)
                  â1,136
                  â1,278
                  â1,592
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â81
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,376
                  1,876
                  1,989
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,592
                  1,376
                  1,876
               
               
                  3200
                  Obligated balance, end of year
                  1,376
                  1,876
                  1,989
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  1,136
                  1,278
                  1,592
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1,136
                  1,278
                  1,592
               
               
                  
                     
                  
               
            
         
      
      
         The Center for Medicare and Medicaid Innovation ("Innovation Center") was established by section 1115A of the Social Security
            Act (as added by section 3021 of the Patient Protection and Affordable Care Act). The Innovation Center is tasked with testing
            innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of
            care provided to individuals under Medicare, Medicaid, or the Children's Health Insurance Program (CHIP). The statute provides
            $10 billion in mandatory funding for these purposes in fiscal years 2011 through 2019.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  62
                  70
                  70
               
               
                  12.1
                  Civilian personnel benefits
                  19
                  22
                  22
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  3
                  3
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  502
                  1,220
                  1,280
               
               
                  41.0
                  Grants, subsidies, and contributions
                  375
                  391
                  224
               
               
                  42.0
                  Insurance claims and indemnities
                  40
                  72
                  105
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,001
                  1,778
                  1,705
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0522â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  551
                  600
                  600
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  2,048
                  570
                  1,160
               
               
                  0198
                  Adjustment for appropriation derived from the general fund of the US Treasury
                  â2,048
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  
                  570
                  1,160
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  Interest, Child Enrollment Contingency Fund
                  6
                  17
                  27
               
               
                  
                  Proposed:
               
               
                  1240
                  Interest, Child Enrollment Contingency Fund
                  
                  35
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  6
                  52
                  27
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  6
                  622
                  1,187
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Child Enrollment Contingency Fund
                  â6
                  â17
                  â27
               
               
                  2103
                  Child Enrollment Contingency Fund
                  â2,048
                  â570
                  â1,160
               
               
                  2134
                  Child Enrollment Contingency Fund
                  
                  1,160
                  
               
               
                  2134
                  Child Enrollment Contingency Fund
                  570
                  
                  
               
               
                  2198
                  Adjustment for appropriation derived from the general fund of the US Treasury
                  2,048
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  564
                  573
                  â1,187
               
               
                  
                  Proposed:
               
               
                  2201
                  Child Enrollment Contingency Fund
                  
                  â35
                  
               
               
                  2234
                  Child Enrollment Contingency Fund
                  
                  
                  667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  â35
                  667
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  564
                  538
                  â520
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  570
                  1,160
                  667
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and US Territories
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3,656
                  573
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0515]
                  â3,656
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  
                  573
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1134
                  Appropriations precluded from obligation
                  
                  â1,160
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,140
                  
                  
               
               
                  1201
                  Appropriation (special or trust fund)
                  6
                  17
                  27
               
               
                  1203
                  Appropriation (previously unavailable)
                  2,048
                  570
                  1,160
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  â2,050
                  
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  â570
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  574
                  587
                  1,187
               
               
                  1900
                  Budget authority (total)
                  574
                  â573
                  1,187
               
               
                  1930
                  Total budgetary resources available
                  574
                  
                  1,187
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  573
                  
                  1,187
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  224
                  198
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â27
                  â198
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  198
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  224
                  198
                  
               
               
                  3200
                  Obligated balance, end of year
                  198
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  â1,160
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  574
                  587
                  1,187
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  27
                  198
                  
               
               
                  4180
                  Budget authority, net (total)
                  574
                  â573
                  1,187
               
               
                  4190
                  Outlays, net (total)
                  27
                  198
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  571
                  1,145
                  1,160
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  1,145
                  1,160
                  1,187
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  574
                  â573
                  1,187
               
               
                  
                  Outlays
                  27
                  198
                  
               
               
                  Legislative proposal, not subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â667
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  2,312
                  â2,332
               
               
                  Total:
               
               
                  
                  Budget Authority
                  574
                  1,739
                  â1,812
               
               
                  
                  Outlays
                  27
                  198
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Children's Health Insurance Program Reauthorization Act of 2009 (P.L. 111â3) established the Child Enrollment Contingency
            Fund under title XXI of the Social Security Act. Beginning in 2009, a State may qualify for a Contingency Fund payment if
            it projects a funding shortfall for the fiscal year and if its average monthly child enrollment exceeds its target average
            number of enrollees for the fiscal year. The Patient Protection and Affordable Care Act of 2010 (P.L. 111â148) extended the
            Contingency Fund through fiscal year 2015. The Medicare Access and CHIP Reauthorization Act of 2015 (P.L. 114â10) extended
            the Contingency Fund through fiscal year 2017. There is no authority to make payments from the Fund in fiscal year 2018.
         
          The Fund receives an appropriation equal to 20 percent of the Sec. 2104(a) CHIP national allotment appropriation under the
            Social Security Act. The Contingency Fund is invested in interest bearing securities of the United States, and the income
            derived from these investments constitutes a part of the fund.
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â2â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1134
                  Appropriations precluded from obligation
                  
                  
                  â667
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â667
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â667
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  
                  â667
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  
                  â667
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â667
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Child Enrollment Contingency Fund                                                                                        
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5551â4â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  2,312
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation (annual appropriation)
                  
                  3,420
                  1,140
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  35
                  
               
               
                  1220
                  Appropriations transferred to other acct [075â0515]
                  
                  â1,143
                  â3,472
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  2,312
                  â2,332
               
               
                  1930
                  Total budgetary resources available
                  
                  2,312
                  â20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  2,312
                  â20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  2,312
                  â2,332
               
               
                  4180
                  Budget authority, net (total)
                  
                  2,312
                  â2,332
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  
                  
                  2,312
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  
                  2,312
                  â20
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to extend the Contingency Fund through fiscal year 2019.
      
         Medicare Health Information Technology Incentive Payments, Recovery Act                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0508â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Incentive payments to hospitals
                  610
                  65
                  20
               
               
                  0802
                  Incentive payments to eligible professionals
                  393
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 42.0)
                  1,003
                  65
                  20
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  6
                  6
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected from the HI Trust Fund
                  649
                  65
                  20
               
               
                  1800
                  Collected from the SMI Trust Fund
                  435
                  
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  1,009
                  65
                  20
               
               
                  1930
                  Total budgetary resources available
                  1,009
                  71
                  26
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6
                  6
                  6
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  80
                  19
                  19
               
               
                  3010
                  New obligations, unexpired accounts
                  1,003
                  65
                  20
               
               
                  3020
                  Outlays (gross)
                  â1,064
                  â65
                  â20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  19
                  19
                  19
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â246
                  â171
                  â171
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â171
                  â171
                  â171
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â166
                  â152
                  â152
               
               
                  3200
                  Obligated balance, end of year
                  â152
                  â152
                  â152
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,009
                  65
                  20
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  984
                  47
                  20
               
               
                  4101
                  Outlays from mandatory balances
                  80
                  18
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,064
                  65
                  20
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â1,084
                  â65
                  â20
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  75
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â20
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â20
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  133
                  133
                  133
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  133
                  133
                  133
               
               
                  
                     
                  
               
            
         
      
         Rate Review Grants                                                                                                       
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0112â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Premium rate review grants
                  26
                  8
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  26
                  8
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  29
                  3
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  6
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  29
                  9
                  20
               
               
                  1930
                  Total budgetary resources available
                  29
                  9
                  20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  3
                  1
                  20
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  71
                  69
                  45
               
               
                  3010
                  New obligations, unexpired accounts
                  26
                  8
                  
               
               
                  3020
                  Outlays (gross)
                  â23
                  â26
                  â13
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â6
                  â19
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  69
                  45
                  13
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  71
                  69
                  45
               
               
                  3200
                  Obligated balance, end of year
                  69
                  45
                  13
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  23
                  26
                  13
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  23
                  26
                  13
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act (P.L. 111â148) amended Section 2794 of the Public Health Service Act and provided
            that the Secretary carry out a program to award grants to States for a five-year period beginning in fiscal year 2010. The
            program provided $250 million in grants to help States develop or enhance their current rate review activities from 2010 through
            2014, with remaining unobligated balances subsequently available for state implementation of consumer protections and other
            insurance reform activities consistent with Section 2794 (c)(2)(B).
         
      
         Pre-Existing Condition Insurance Plan Program                                                                            
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0113â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pre-Existing Condition Insurance Plan Program (Direct)
                  66
                  
                  
               
               
                  0002
                  Administration
                  
                  103
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  66
                  103
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 25.2)
                  66
                  103
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  389
                  332
                  230
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  8
                  1
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  398
                  333
                  230
               
               
                  1930
                  Total budgetary resources available
                  398
                  333
                  230
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  332
                  230
                  230
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  13
                  38
                  56
               
               
                  3010
                  New obligations, unexpired accounts
                  66
                  103
                  
               
               
                  3020
                  Outlays (gross)
                  â33
                  â84
                  â56
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â8
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  38
                  56
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  13
                  38
                  56
               
               
                  3200
                  Obligated balance, end of year
                  38
                  56
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  33
                  84
                  56
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  32
                  84
                  56
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  32
                  84
                  56
               
               
                  
                     
                  
               
            
         
      
      
         This account funds the Pre-Existing Condition Insurance Plan program (PCIP), which made health insurance available to people
            who had been unable to purchase insurance due to a pre-existing condition. Enrollees paid monthly premiums similar to those
            charged in the commercial individual market, and the Federal government pays for remaining costs that exceed enrollee contributions.
            The funding for this program, including operating costs, was provided in the Patient Protection and Affordable Care Act (P.L.
            111â148). The PCIP program ended in fiscal year 2014, and outlays reflected in subsequent fiscal years reflect program close
            out and claims run out costs, as well as allowable administrative costs in the current year.
         
      
         Early Retiree Reinsurance Program                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0114â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  26
                  26
                  26
               
               
                  1930
                  Total budgetary resources available
                  26
                  26
                  26
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  26
                  26
                  26
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  10
                  10
                  4
               
               
                  3020
                  Outlays (gross)
                  
                  â6
                  â4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  10
                  4
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  10
                  10
                  4
               
               
                  3200
                  Obligated balance, end of year
                  10
                  4
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  
                  6
                  4
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  6
                  4
               
               
                  
                     
                  
               
            
         
      
      
         The Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated $5 billion for the Early Retiree
            Reinsurance Program (ERRP). By statute, ERRP sunset on January 1, 2014, and is no longer providing reimbursements to plan
            sponsors.
         
      
         Affordable Insurance Exchange Grants                                                                                     
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Administration
                  18
                  13
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  19
                  14
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  18
                  13
                  
               
               
                  1930
                  Total budgetary resources available
                  18
                  13
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  342
                  146
                  24
               
               
                  3010
                  New obligations, unexpired accounts
                  18
                  13
                  
               
               
                  3020
                  Outlays (gross)
                  â160
                  â135
                  â24
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â54
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  146
                  24
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  342
                  146
                  24
               
               
                  3200
                  Obligated balance, end of year
                  146
                  24
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  18
                  13
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  9
                  9
                  
               
               
                  4101
                  Outlays from mandatory balances
                  151
                  126
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  160
                  135
                  24
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â13
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  18
                  13
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  147
                  135
                  24
               
               
                  4180
                  Budget authority, net (total)
                  18
                  13
                  
               
               
                  4190
                  Outlays, net (total)
                  147
                  135
                  24
               
               
                  
                     
                  
               
            
         
      
      
         This program provided funding for Planning and Establishment Grants to States for their activities to implement Health Insurance
            Exchanges. The Exchanges facilitate the purchase of qualified health plans in the individual market and allow small businesses
            to offer qualified health plans to their employees through the Small Business Health Options Program (SHOP). Section 1311
            of the Patient Protection and Affordable Care Act (P.L. 111â148) provided amounts necessary to enable the Secretary to award
            grants to States beginning no later than March 23, 2011, and allowed for renewal of grants through January 1, 2015. The final
            round of grants was awarded to States in December 2014.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  3
                  3
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  15
                  10
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  18
                  13
                  
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0115â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  25
                  26
                  
               
               
                  
                     
                  
               
            
         
      
         Cost-sharing Reductions                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Cost Sharing Reductions
                  
                  7,197
                  7,507
               
               
                  0002
                  Basic Health Program
                  
                  1,000
                  1,060
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  8,197
                  8,567
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  8,197
                  8,567
               
               
                  1930
                  Total budgetary resources available
                  
                  8,197
                  8,567
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  8,197
                  8,567
               
               
                  3020
                  Outlays (gross)
                  
                  â8,197
                  â8,567
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  8,197
                  8,567
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  8,197
                  8,567
               
               
                  4180
                  Budget authority, net (total)
                  
                  8,197
                  8,567
               
               
                  4190
                  Outlays, net (total)
                  
                  8,197
                  8,567
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  
                  8,197
                  8,567
               
               
                  
                  Outlays
                  
                  8,197
                  8,567
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  â180
                  â471
               
               
                  
                  Outlays
                  
                  â180
                  â471
               
               
                  Total:
               
               
                  
                  Budget Authority
                  
                  8,017
                  8,096
               
               
                  
                  Outlays
                  
                  8,017
                  8,096
               
               
                  
                     
                  
               
            
         
      
      
         Under current law, insurers are required to offer reduced cost-sharing to eligible, low-income consumers.  The FY 2019 Budget
            provides a mandatory appropriation for Cost Sharing Reduction (CSR) payments for fiscal year 2018 through the end of calendar
            year 2019.
         
      
         Cost-sharing Reductions                                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0126â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Cost Sharing Reductions
                  
                  â180
                  â471
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  â180
                  â471
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  â180
                  â471
               
               
                  1930
                  Total budgetary resources available
                  
                  â180
                  â471
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  â180
                  â471
               
               
                  3020
                  Outlays (gross)
                  
                  180
                  471
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  â180
                  â471
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  â180
                  â471
               
               
                  4180
                  Budget authority, net (total)
                  
                  â180
                  â471
               
               
                  4190
                  Outlays, net (total)
                  
                  â180
                  â471
               
               
                  
                     
                  
               
            
         
      
         Risk Adjustment Program Payments                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  248
                  371
                  526
               
               
                  0198
                  Reconciliation adjustment
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  247
                  371
                  526
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Receipts, Risk Adjustment Program
                  5,228
                  7,974
                  7,094
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  5,475
                  8,345
                  7,620
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Risk Adjustment Program Payments
                  â5,228
                  â7,974
                  â7,094
               
               
                  2103
                  Risk Adjustment Program Payments
                  â247
                  â371
                  â526
               
               
                  2132
                  Risk Adjustment Program Payments
                  371
                  526
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â5,104
                  â7,819
                  â7,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â5,104
                  â7,819
                  â7,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  371
                  526
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5733â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Risk Adjustment Program Payments (Direct)
                  3,768
                  9,154
                  7,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  3,768
                  9,154
                  7,620
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  1,336
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  5,228
                  7,974
                  7,094
               
               
                  1203
                  Appropriation (previously unavailable)
                  247
                  371
                  526
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â371
                  â526
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  5,104
                  7,819
                  7,620
               
               
                  1930
                  Total budgetary resources available
                  5,104
                  9,155
                  7,621
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1,336
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,247
                  915
                  915
               
               
                  3010
                  New obligations, unexpired accounts
                  3,768
                  9,154
                  7,620
               
               
                  3020
                  Outlays (gross)
                  â4,100
                  â9,154
                  â7,620
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  915
                  915
                  915
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,247
                  915
                  915
               
               
                  3200
                  Obligated balance, end of year
                  915
                  915
                  915
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  5,104
                  7,819
                  7,620
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,853
                  7,447
                  7,620
               
               
                  4101
                  Outlays from mandatory balances
                  1,247
                  1,707
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,100
                  9,154
                  7,620
               
               
                  4180
                  Budget authority, net (total)
                  5,104
                  7,819
                  7,620
               
               
                  4190
                  Outlays, net (total)
                  4,100
                  9,154
                  7,620
               
               
                  
                     
                  
               
            
         
      
      
         Section 1343 of the Patient Protection and Affordable Care Act (P.L. 111â148) established a permanent risk adjustment program
            for non-grandfathered plans in the individual and small group markets. Risk adjustment is budget neutral within each state
            and market, such that charges collected from plans with lower than average actuarial risk are used to make payments to plans
            with higher than average actuarial risk. Risk adjustment may be operated by a State, or by the Federal government in the event
            a State chooses not to operate risk adjustment. Payments and charges are made in the year following the plan year for which
            they are calculated.
         
      
         Transitional Reinsurance Program                                                                                         
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  455
                  285
                  22
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Contributions, Transitional Reinsurance Program
                  4,546
                  376
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  5,001
                  661
                  22
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Transitional Reinsurance Program
                  â4,546
                  â375
                  
               
               
                  2103
                  Transitional Reinsurance Program
                  â456
                  â286
                  â22
               
               
                  2132
                  Transitional Reinsurance Program
                  286
                  22
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â4,716
                  â639
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â4,716
                  â639
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  285
                  22
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Transitional reinsurance payments
                  4,715
                  632
                  22
               
               
                  0002
                  Administrative expenses
                  1
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  4,716
                  639
                  22
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  4,546
                  375
                  
               
               
                  1203
                  Appropriation (previously unavailable)
                  456
                  286
                  22
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â286
                  â22
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  4,716
                  639
                  22
               
               
                  1930
                  Total budgetary resources available
                  4,716
                  639
                  22
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  223
                  248
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  4,716
                  639
                  22
               
               
                  3020
                  Outlays (gross)
                  â4,691
                  â887
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  248
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  223
                  248
                  
               
               
                  3200
                  Obligated balance, end of year
                  248
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,716
                  639
                  22
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  4,468
                  639
                  22
               
               
                  4101
                  Outlays from mandatory balances
                  223
                  248
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,691
                  887
                  22
               
               
                  4180
                  Budget authority, net (total)
                  4,716
                  639
                  22
               
               
                  4190
                  Outlays, net (total)
                  4,691
                  887
                  22
               
               
                  
                     
                  
               
            
         
      
      
         Section 1341 of the Patient Protection and Affordable Care Act (P.L. 111â148) established a transitional, temporary, three-year
            reinsurance program to minimize the impact of high-cost enrollees in plans in the individual market for plan years 2014, 2015,
            and 2016. The Centers for Medicare & Medicaid Services assesses contributing entities a per enrollee fee to fund the reinsurance
            program, and makes payments to issuers in the individual market for enrollees whose medical costs exceed a certain threshold,
            up to a reinsurance cap. Reinsurance collections and payments are made in the year following the plan year for which they
            are applicable. Reinsurance collections and payments for the 2016 plan year, the final year of the program, were announced
            in June of 2017.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5735â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Grants, subsidies, and contributions - Transitional Reinsurance
                  4,715
                  632
                  22
               
               
                  41.0
                  Grants, subsidies, and contributions - Administration
                  1
                  7
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,716
                  639
                  22
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0705
                  Reestimates of direct loan subsidy
                  16
                  124
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  1
                  11
                  
               
               
                  0709
                  Administrative expenses
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  18
                  135
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  1
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  17
                  134
                  
               
               
                  1930
                  Total budgetary resources available
                  18
                  135
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  16
                  3
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  18
                  135
                  
               
               
                  3020
                  Outlays (gross)
                  â30
                  â136
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  16
                  3
                  1
               
               
                  3200
                  Obligated balance, end of year
                  3
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  17
                  134
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  17
                  134
                  
               
               
                  4101
                  Outlays from mandatory balances
                  13
                  2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  30
                  136
                  
               
               
                  4180
                  Budget authority, net (total)
                  17
                  134
                  
               
               
                  4190
                  Outlays, net (total)
                  30
                  136
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan subsidy outlays:
               
               
                  134002
                  Solvency Loans
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  134999
                  Total subsidy outlays
                  13
                  
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135001
                  Startup Loans
                  â8
                  17
                  
               
               
                  135002
                  Solvency Loans
                  5
                  117
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  â3
                  134
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  
                  2
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Consumer Operated and Oriented Plan Contingency Fund was established by the American Taxpayer Relief Act of 2012 (P.L.
            112â240). This fund provides assistance and oversight to qualified nonprofit health insurance issuers that have been awarded
            loans or grants under section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0524â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  17
                  135
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  18
                  135
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Account                                                                      
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  7
                  
                  
               
               
                  0198
                  Reconciliation adjustment
                  â7
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0705
                  Reestimates of direct loan subsidy
                  74
                  226
                  
               
               
                  0706
                  Interest on reestimates of direct loan subsidy
                  7
                  33
                  
               
               
                  0709
                  Administrative expenses
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  82
                  259
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  81
                  259
                  
               
               
                  1930
                  Total budgetary resources available
                  82
                  260
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3
                  4
                  2
               
               
                  3010
                  New obligations, unexpired accounts
                  82
                  259
                  
               
               
                  3020
                  Outlays (gross)
                  â81
                  â260
                  
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4
                  2
                  2
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  3
                  4
                  2
               
               
                  3200
                  Obligated balance, end of year
                  4
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  81
                  259
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  81
                  259
                  
               
               
                  4101
                  Outlays from mandatory balances
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  81
                  260
                  
               
               
                  4180
                  Budget authority, net (total)
                  81
                  259
                  
               
               
                  4190
                  Outlays, net (total)
                  81
                  260
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Loan Levels, Subsidy Budget Authority and Outlays by Program (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct loan reestimates:
               
               
                  135002
                  Startup Loans
                  â65
                  â8
                  
               
               
                  135003
                  Solvency  Loans
                  38
                  252
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  135999
                  Total direct loan reestimates
                  â27
                  244
                  
               
               
                  
                     
                  
               
               
                  
                  Administrative expense data:
               
               
                  3580
                  Outlays from balances
                  
                  1
                  
               
               
                  
                     
                  
               
            
         
      
      
         Section 1322 of the Patient Protection and Affordable Care Act (P.L. 111â148) authorized and appropriated funding for the
            Consumer Operated and Oriented Plan (CO-OP) Program. The CO-OP Program fosters the creation of qualified nonprofit health
            insurance issuers that operate with a strong consumer focus to offer qualified health plans in the individual and small group
            markets in the States. The Secretary shall award loans to qualified nonprofit issuers to fund start-up costs and reserves
            which enable qualified issuers to meet state solvency requirements. The Secretary may also award loans for the purposes of
            encouraging the establishment of CO-OPs in states where no issuer applies to be a qualified nonprofit issuer under Section
            1322.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0118â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  81
                  259
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  82
                  259
                  
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Financing Account                                                                    
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  18
                  18
                  15
               
               
                  0742
                  Downward reestimates paid to receipt accounts
                  99
                  14
                  
               
               
                  0743
                  Interest on downward reestimates
                  8
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  125
                  33
                  15
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  523
                  143
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  
                  3
                  
               
               
                  1022
                  Capital transfer of unobligated balances to general fund
                  â1
                  
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â478
                  â143
                  
               
               
                  1024
                  Unobligated balance of borrowing authority withdrawn
                  
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  44
                  
                  
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  121
                  15
                  
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  103
                  369
                  114
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  
                  â1
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â350
                  â99
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  103
                  18
                  15
               
               
                  1900
                  Budget authority (total)
                  224
                  33
                  15
               
               
                  1930
                  Total budgetary resources available
                  268
                  33
                  15
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  143
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  3
                  3
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  125
                  33
                  15
               
               
                  3020
                  Outlays (gross)
                  â125
                  â33
                  â15
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  3
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1
                  â1
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  2
                  2
                  
               
               
                  3200
                  Obligated balance, end of year
                  2
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  224
                  33
                  15
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  125
                  33
                  15
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â80
                  â259
                  
               
               
                  4122
                  Interest on uninvested funds
                  â6
                  â2
                  â1
               
               
                  4123
                  Non-Federal sources
                  â17
                  â108
                  â113
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â103
                  â369
                  â114
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  121
                  â335
                  â99
               
               
                  4170
                  Outlays, net (mandatory)
                  22
                  â336
                  â99
               
               
                  4180
                  Budget authority, net (total)
                  121
                  â335
                  â99
               
               
                  4190
                  Outlays, net (total)
                  22
                  â336
                  â99
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  1,909
                  1,893
                  1,785
               
               
                  1251
                  Repayments: Repayments and prepayments
                  â16
                  â108
                  â112
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â493
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  1,893
                  1,785
                  1,180
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4418â0â3â551
                  2016 actual
                  2017 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  
                  Federal assets:
               
               
                  1101
                  Fund balances with Treasury
                  506
                  16
               
               
                  
                  Investments in US securities:
               
               
                  1106
                  Receivables, net
                  81
                  
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  1,909
                  1,893
               
               
                  1402
                  Interest receivable
                  12
                  20
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â1,284
                  â1,278
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  637
                  635
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  1,224
                  651
               
               
                  
                  LIABILITIES:
               
               
                  2103
                  Federal liabilities: Debt
                  1,224
                  651
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  1,224
                  651
               
               
                  
                     
                  
               
            
         
      
         Consumer Operated and Oriented Plan Program Contingency Fund Financing Account                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  
                  Credit program obligations:
               
               
                  0713
                  Payment of interest to Treasury
                  6
                  6
                  5
               
               
                  0742
                  Downward reestimates paid to receipt accounts
                  19
                  
                  
               
               
                  0743
                  Interest on downward reestimates
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  26
                  6
                  5
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  101
                  32
                  1
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  3
                  
               
               
                  1023
                  Unobligated balances applied to repay debt
                  â93
                  â32
                  
               
               
                  1024
                  Unobligated balance of borrowing authority withdrawn
                  
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  10
                  
                  1
               
               
                  
                  Financing authority:
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  30
                  7
                  9
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  31
                  138
                  4
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â13
                  â1
                  
               
               
                  1825
                  Spending authority from offsetting collections applied to repay debt
                  
                  â137
                  â4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  18
                  
                  
               
               
                  1900
                  Budget authority (total)
                  48
                  7
                  9
               
               
                  1930
                  Total budgetary resources available
                  58
                  7
                  10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  32
                  1
                  5
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  34
                  4
                  1
               
               
                  3010
                  New obligations, unexpired accounts
                  26
                  6
                  5
               
               
                  3020
                  Outlays (gross)
                  â54
                  â6
                  â5
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  â3
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4
                  1
                  1
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â14
                  â1
                  
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  13
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  20
                  3
                  1
               
               
                  3200
                  Obligated balance, end of year
                  3
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Financing authority and disbursements, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  48
                  7
                  9
               
               
                  
                  Financing disbursements:
               
               
                  4110
                  Outlays, gross (total)
                  54
                  6
                  5
               
               
                  
                  Offsets against gross financing authority and disbursements:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â29
                  â134
                  
               
               
                  4122
                  Interest on uninvested funds
                  â2
                  â2
                  â2
               
               
                  4123
                  Non-Federal sources
                  
                  â2
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â31
                  â138
                  â4
               
               
                  
                  Additional offsets against financing authority only (total):
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  13
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  30
                  â130
                  5
               
               
                  4170
                  Outlays, net (mandatory)
                  23
                  â132
                  1
               
               
                  4180
                  Budget authority, net (total)
                  30
                  â130
                  5
               
               
                  4190
                  Outlays, net (total)
                  23
                  â132
                  1
               
               
                  
                     
                  
               
            
         
      
      Status of Direct Loans (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Cumulative balance of direct loans outstanding:
               
               
                  1210
                  Outstanding, start of year
                  451
                  480
                  478
               
               
                  1231
                  Disbursements: Direct loan disbursements
                  29
                  
                  
               
               
                  1251
                  Repayments: Repayments and prepayments
                  
                  â2
                  â2
               
               
                  1263
                  Write-offs for default: Direct loans
                  
                  
                  â138
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1290
                  Outstanding, end of year
                  480
                  478
                  338
               
               
                  
                     
                  
               
            
         
      
      Balance Sheet (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â4482â0â3â551
                  2016 actual
                  2017 actual
               
               
                  
                     
                  
               
               
                  
                  ASSETS:
               
               
                  1101
                  Federal assets: Fund balances with Treasury
                  124
                  9
               
               
                  1206
                  Non-Federal assets: Receivables, net
                  17
                  4
               
               
                  
                  Net value of assets related to post-1991 direct loans receivable:
               
               
                  1401
                  Direct loans receivable, gross
                  451
                  480
               
               
                  1402
                  Interest receivable
                  2
                  
               
               
                  1405
                  Allowance for subsidy cost (-)
                  â281
                  â291
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1499
                  Net present value of assets related to direct loans
                  172
                  189
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total assets
                  313
                  202
               
               
                  
                  LIABILITIES:
               
               
                  2104
                  Federal liabilities: Resources payable to Treasury
                  293
                  202
               
               
                  2207
                  Non-Federal liabilities: Other
                  20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total liabilities
                  313
                  202
               
               
                  
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total liabilities and net position
                  313
                  202
               
               
                  
                     
                  
               
            
         
      
      Trust Funds  
         Federal Hospital Insurance Trust Fund                                                                                    
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  158,585
                  160,218
                  164,640
               
               
                  0198
                  Unavailable unobligated balance adjustment
                  127
                  
                  
               
               
                  0198
                  Adjustment for change in allocation
                  
                  â197
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  158,712
                  160,021
                  164,640
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  237,667
                  240,175
                  255,083
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  606
                  567
                  587
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  17,657
                  18,396
                  19,544
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  446
                  641
                  683
               
               
                  1130
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  1
                  2
                  2
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  389
                  398
                  429
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  5,841
                  6,300
                  6,350
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  1
                  3
                  3
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,492
                  3,733
                  3,948
               
               
                  1140
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,733
                  3,838
                  3,937
               
               
                  1140
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  683
                  639
                  625
               
               
                  1140
                  FHI Trust Fund, Interest Received by Trust Funds
                  7,423
                  7,168
                  6,880
               
               
                  1140
                  FHI Trust Fund, Taxation on OASDI Benefits
                  24,206
                  23,684
                  24,943
               
               
                  1140
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  131
                  135
                  147
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  12
                  109
                  150
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  46
                  51
                  52
               
               
                  1140
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  25
                  30
                  31
               
               
                  1140
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  31
                  26
                  28
               
               
                  1140
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,973
                  1,323
                  1,330
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  304,363
                  307,218
                  324,752
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â2
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  â50
                  2
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â190
               
               
                  1240
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  32
                  270
               
               
                  1240
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  â18
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  304,363
                  307,200
                  324,834
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  463,075
                  467,221
                  489,474
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â2,110
                  â1,933
                  â2,022
               
               
                  2101
                  Federal Hospital Insurance Trust Fund
                  â300,240
                  â305,249
                  â325,008
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â725
                  â725
                  â770
               
               
                  2101
                  Health Care Fraud and Abuse Control Account
                  â1,320
                  â1,320
                  â1,186
               
               
                  2132
                  Federal Hospital Insurance Trust Fund
                  7
                  
                  
               
               
                  2132
                  Health Care Fraud and Abuse Control Account
                  50
                  50
                  
               
               
                  2134
                  Federal Hospital Insurance Trust Fund
                  1,449
                  6,614
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â302,889
                  â302,563
                  â328,984
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  33
                  270
               
               
                  2201
                  Federal Hospital Insurance Trust Fund
                  
                  
                  192
               
               
                  2203
                  Federal Hospital Insurance Trust Fund
                  
                  â33
                  â270
               
               
                  2203
                  Federal Hospital Insurance Trust Fund
                  
                  â18
                  13,083
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  â18
                  13,275
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â302,889
                  â302,581
                  â315,709
               
               
                  5098
                  Unavailable unobligated balance adjustment
                  32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  160,218
                  164,640
                  173,765
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  297,122
                  297,842
                  323,801
               
               
                  0002
                  HIT Incentive Payments
                  648
                  65
                  20
               
               
                  0003
                  Administration, HI
                  2,580
                  2,130
                  2,227
               
               
                  0004
                  Quality improvement organizations, HI
                  552
                  522
                  980
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  300,902
                  300,559
                  327,028
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  300,902
                  300,559
                  327,028
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  8
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  2,110
                  1,933
                  2,022
               
               
                  1130
                  Appropriations permanently reduced
                  
                  â9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  2,110
                  1,924
                  2,022
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  300,240
                  305,249
                  325,008
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced (Sequester)
                  â7
                  
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  â1,449
                  â6,614
                  â2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  298,784
                  298,635
                  325,006
               
               
                  1900
                  Budget authority (total)
                  300,894
                  300,559
                  327,028
               
               
                  1930
                  Total budgetary resources available
                  300,902
                  300,559
                  327,028
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  31,859
                  35,193
                  35,141
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  
                  197
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  300,902
                  300,559
                  327,028
               
               
                  3020
                  Outlays (gross)
                  â297,566
                  â300,808
                  â327,099
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  35,193
                  35,141
                  35,070
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  31,859
                  35,390
                  35,141
               
               
                  3200
                  Obligated balance, end of year
                  35,193
                  35,141
                  35,070
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,110
                  1,924
                  2,022
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,254
                  1,230
                  1,357
               
               
                  4011
                  Outlays from discretionary balances
                  
                  906
                  709
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,254
                  2,136
                  2,066
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  298,784
                  298,635
                  325,006
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  269,052
                  267,101
                  293,667
               
               
                  4101
                  Outlays from mandatory balances
                  27,260
                  31,571
                  31,366
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  296,312
                  298,672
                  325,033
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â6
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  298,784
                  298,635
                  325,006
               
               
                  4170
                  Outlays, net (mandatory)
                  296,306
                  298,672
                  325,033
               
               
                  4180
                  Budget authority, net (total)
                  300,894
                  300,559
                  327,028
               
               
                  4190
                  Outlays, net (total)
                  297,560
                  300,808
                  327,099
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  192,209
                  197,835
                  200,449
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  197,835
                  200,449
                  209,551
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  300,894
                  300,559
                  327,028
               
               
                  
                  Outlays
                  297,560
                  300,808
                  327,099
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  18
                  â13,275
               
               
                  
                  Outlays
                  
                  18
                  â13,275
               
               
                  Total:
               
               
                  
                  Budget Authority
                  300,894
                  300,577
                  313,753
               
               
                  
                  Outlays
                  297,560
                  300,826
                  313,824
               
               
                  
                     
                  
               
            
         
      
      
         The Hospital Insurance (HI) program funds the costs of hospital and related care for individuals age 65 or older and for eligible
            disabled persons.
         
         In addition, the Budget includes a package of targeted Medicare proposals designed to eliminate wasteful Federal spending,
            reduce provider burden, and address fraud and abuse. This package strengthens the solvency of the Hospital Insurance Trust
            Fund.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  192,518
                  197,520
                  201,343
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  192,518
                  197,520
                  201,343
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  237,667
                  240,175
                  255,083
               
               
                  1110
                  FHI Trust Fund, Receipts from Railroad Retirement Board
                  606
                  567
                  587
               
               
                  1110
                  FHI Trust Fund, Transfers from General Fund (SECA Taxes)
                  17,657
                  18,396
                  19,544
               
               
                  1110
                  FHI Trust Fund, Civil Penalties and Damages
                  446
                  641
                  683
               
               
                  1130
                  FHI Trust Fund, Basic Premium, Medicare Advantage
                  389
                  398
                  429
               
               
                  1130
                  FHI Trust Fund, Medicare Refunds
                  5,841
                  6,300
                  6,350
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models (HI)
                  1
                  3
                  3
               
               
                  1130
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  3,492
                  3,733
                  3,948
               
               
                  1130
                  Federal Hospital Insurance Trust Fund
                  6
                  
                  
               
               
                  1150
                  FHI Trust Fund, Interest Received by Trust Funds
                  7,423
                  7,168
                  6,880
               
               
                  1150
                  FHI Trust Fund, Other Proprietary Interest from the Public
                  1
                  2
                  2
               
               
                  1150
                  FHI Trust Fund, Interest Payments by Railroad Retirement Board
                  31
                  26
                  28
               
               
                  1160
                  FHI Trust Fund, Federal Employer Contributions (FICA)
                  3,733
                  3,838
                  3,937
               
               
                  1160
                  FHI Trust Fund, Postal Service Employer Contributions (FICA)
                  683
                  639
                  625
               
               
                  1160
                  FHI Trust Fund, Taxation on OASDI Benefits
                  24,206
                  23,684
                  24,943
               
               
                  1160
                  FHI Trust Fund, Payment from the General Fund for Health Care Fraud and Abuse Control Account
                  131
                  135
                  147
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (criminal Fines)
                  12
                  109
                  150
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  46
                  51
                  52
               
               
                  1160
                  FHI Trust Fund, Transfers from General Fund (asset Forfeitures)
                  25
                  30
                  31
               
               
                  1160
                  FHI Trust Fund, Payments from the General Fund (uninsured and Program Management)
                  1,973
                  1,323
                  1,330
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  304,369
                  307,218
                  324,752
               
               
                  
                  Proposed:
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  
                  â2
               
               
                  1210
                  FHI Trust Fund, Transfers from General Fund (FICA Taxes)
                  
                  â50
                  2
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  FHI Trust Fund, Premiums Collected for Uninsured Individuals not Otherwise Eligible
                  
                  
                  â190
               
               
                  1250
                  FHI Trust Fund, Interest Received by Trust Funds
                  
                  32
                  270
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  FHI Trust Fund, Transfers from General Fund (civil Monetary Penalties)
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  â18
                  82
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  304,369
                  307,200
                  324,834
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Hospital Insurance Trust Fund [009â38â8005â0]
                  â297,566
                  â300,808
                  â327,099
               
               
                  2100
                  Health Care Fraud and Abuse Control Account [009â38â8393â0]
                  â1,802
                  â2,542
                  â2,228
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â299,368
                  â303,350
                  â329,327
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Hospital Insurance Trust Fund
                  
                  â18
                  13,275
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  â18
                  13,275
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â299,368
                  â303,368
                  â316,052
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  â2,454
                  â3,396
                  1,602
               
               
                  3120
                  Interest
                  7,455
                  7,228
                  7,180
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  5,001
                  3,832
                  8,782
               
               
                  3220
                  Federal Hospital Insurance Trust Fund
                  
                  â9
                  
               
               
                  3298
                  Rounding adjustment
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  1
                  â9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  5,002
                  3,823
                  8,782
               
               
                  
                  Unexpended balance, end of year::
               
               
                  4100
                  Uninvested balance (net), end of year
                  â315
                  894
                  574
               
               
                  4200
                  Federal Hospital Insurance Trust Fund
                  197,835
                  200,449
                  209,551
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  197,520
                  201,343
                  210,125
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activities
                  552
                  522
                  980
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  297,770
                  297,907
                  323,821
               
               
                  94.0
                  Financial transfers
                  2,580
                  2,130
                  2,227
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  300,902
                  300,559
                  327,028
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  2
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â2â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  â33
                  â270
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  33
                  270
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Federal Hospital Insurance Trust Fund                                                                                    
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â4â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, HI
                  
                  
                  â13,293
               
               
                  0003
                  Administration, HI
                  
                  18
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  18
                  â13,275
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  18
                  â13,275
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â192
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  18
                  â13,083
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  18
                  â13,275
               
               
                  1900
                  Budget authority (total)
                  
                  18
                  â13,275
               
               
                  1930
                  Total budgetary resources available
                  
                  18
                  â13,275
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  18
                  â13,275
               
               
                  3020
                  Outlays (gross)
                  
                  â18
                  13,275
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  18
                  â13,275
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  18
                  â13,275
               
               
                  4180
                  Budget authority, net (total)
                  
                  18
                  â13,275
               
               
                  4190
                  Outlays, net (total)
                  
                  18
                  â13,275
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8005â4â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities (benefits)
                  
                  
                  â13,293
               
               
                  94.0
                  Financial transfers
                  
                  18
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  18
                  â13,275
               
               
                  
                     
                  
               
            
         
      
         health care fraud and abuse control accountIn addition to amounts otherwise available for program integrity and program management, $770,000,000, to remain available through September 30, 2020, to be transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund,
            as authorized by section 201(g) of the Social Security Act, of which $604,389,000 shall be for the Centers for Medicare and Medicaid Services program integrity activities, of which $87,230,000 shall be for the Department of Health and Human Services Office of Inspector General to carry out fraud and abuse activities
            authorized by section 1817(k)(3) of such Act, and of which $78,381,000 shall be for the Department of Justice to carry out fraud and abuse activities authorized by section 1817(k)(3) of such Act:
            Provided, That the report required by section 1817(k)(5) of the Social Security Act for fiscal year 2019 shall include measures of the operational efficiency and impact on fraud, waste, and abuse in the Medicare, Medicaid, and
            CHIP programs for the funds provided by this appropriation: Provided further, That of the amount provided under this heading, $311,000,000 is provided to meet the terms of section 251(b)(2)(C)(ii) of
            the Balanced Budget and Emergency Deficit Control Act of 1985, as amended, and $454,000,000 is additional new budget authority specified for purposes of section 251(b)(2)(C) of such Act: Provided further, That the Secretary shall support the Senior Medicare Patrol program to combat health care fraud and abuse from the funds
            provided to this account.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare integrity program
                  795
                  877
                  917
               
               
                  0002
                  FBI fraud and abuse control
                  131
                  135
                  147
               
               
                  0003
                  Other fraud and abuse control
                  279
                  286
                  313
               
               
                  0005
                  Undistributed Savings, HCFAC and SSA
                  
                  â28
                  â191
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Total Mandatory
                  1,205
                  1,270
                  1,186
               
               
                  0101
                  CMS discretionary
                  614
                  569
                  604
               
               
                  0102
                  Other discretionary
                  156
                  156
                  166
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Total Discretionary
                  770
                  725
                  770
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,975
                  1,995
                  1,956
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  406
                  430
                  430
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  248
                  199
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  10
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  416
                  430
                  430
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  725
                  725
                  770
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  1,320
                  1,320
                  1,186
               
               
                  1232
                  Appropriations and/or unobligated balance of appropriations temporarily reduced
                  â50
                  â50
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,270
                  1,270
                  1,186
               
               
                  1900
                  Budget authority (total)
                  1,995
                  1,995
                  1,956
               
               
                  1930
                  Total budgetary resources available
                  2,411
                  2,425
                  2,386
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â6
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  430
                  430
                  430
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1951
                  Unobligated balance expiring
                  6
                  
                  
               
               
                  1952
                  Expired unobligated balance, start of year
                  39
                  28
                  28
               
               
                  1953
                  Expired unobligated balance, end of year
                  22
                  28
                  28
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,617
                  1,764
                  1,217
               
               
                  3010
                  New obligations, unexpired accounts
                  1,975
                  1,995
                  1,956
               
               
                  3020
                  Outlays (gross)
                  â1,802
                  â2,542
                  â2,228
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â10
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â16
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,764
                  1,217
                  945
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,617
                  1,764
                  1,217
               
               
                  3200
                  Obligated balance, end of year
                  1,764
                  1,217
                  945
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  725
                  725
                  770
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  122
                  725
                  770
               
               
                  4011
                  Outlays from discretionary balances
                  485
                  83
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  607
                  808
                  770
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,270
                  1,270
                  1,186
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  497
                  897
                  754
               
               
                  4101
                  Outlays from mandatory balances
                  698
                  837
                  704
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,195
                  1,734
                  1,458
               
               
                  4180
                  Budget authority, net (total)
                  1,995
                  1,995
                  1,956
               
               
                  4190
                  Outlays, net (total)
                  1,802
                  2,542
                  2,228
               
               
                  
                     
                  
               
            
         
      
      
         The Health Insurance Portability and Accountability Act of 1996 (P.L. 104â191) established the Health Care Fraud and Abuse
            Control (HCFAC) account within the Federal Hospital Insurance Trust Fund and appropriated funds from the Trust Fund to the
            HCFAC account for specified health care fraud and abuse control activities of the Department of Health and Human Services
            (HHS), the Department of Justice, and other agencies.
         
         The Budget includes a discretionary request for efforts to safeguard Centers for Medicare and Medicaid Services (CMS) program
            integrity that will supplement other CMS program integrity funds. See additional discussion in the Budget Process chapter
            in the Analytical Perspectives volume.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent (CMS)
                  46
                  46
                  46
               
               
                  12.1
                  Civilian personnel benefits (CMS)
                  12
                  12
                  12
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  12
                  12
                  12
               
               
                  25.2
                  Other services (CMS/Medicaid)
                  68
                  82
                  114
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/DOJ)
                  132
                  132
                  143
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OIG)
                  274
                  279
                  302
               
               
                  25.3
                  Other purchases of goods and services from Government accounts (HHS/OGC)
                  7
                  7
                  7
               
               
                  25.3
                  Other goods and services from Federal sources (HHS/CMS)
                  8
                  19
                  21
               
               
                  25.3
                  Other goods and services from Government accounts (HHS/FDA)
                  5
                  5
                  5
               
               
                  25.6
                  Medical care  (CMS)
                  1,280
                  1,294
                  1,338
               
               
                  92.0
                  Undistributed
                  
                  â28
                  â191
               
               
                  94.0
                  Financial transfers (FBI)
                  131
                  135
                  147
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,975
                  1,995
                  1,956
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8393â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  481
                  403
                  403
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  39,603
                  47,105
                  75,604
               
               
                  0198
                  Obligated balance (unpaid obligations) adjustment
                  
                  â298
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0199
                  Balance, start of year
                  39,603
                  46,807
                  75,604
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  4,147
                  5,997
                  2,826
               
               
                  1130
                  Other Proprietary Interest from the Public, FSMI Fund
                  7
                  3
                  3
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  4,936
                  5,240
                  5,656
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  11,072
                  11,938
                  12,558
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  457
                  492
                  553
               
               
                  1130
                  Medicare Refunds, SMI
                  5,011
                  5,242
                  5,292
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  1
                  3
                  3
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  67,357
                  78,021
                  84,296
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  12,326
                  12,461
                  12,648
               
               
                  1140
                  Federal Contributions, FSMI Fund
                  227,879
                  244,685
                  263,711
               
               
                  1140
                  Interest Received by Trust Fund, FSMI Fund
                  2,262
                  1,227
                  1,210
               
               
                  1140
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  3
                  4
               
               
                  1140
                  Interest, Medicare Prescription Drug Account, FSMI
                  53
                  22
                  15
               
               
                  1140
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  â131
                  422
                  642
               
               
                  1140
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  78,791
                  71,915
                  73,171
               
               
                  1140
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  2
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  414,170
                  437,672
                  462,589
               
               
                  
                  Proposed:
               
               
                  1230
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  922
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â160
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â711
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â107
               
               
                  1240
                  Federal Contributions, FSMI Fund
                  
                  
                  â2,484
               
               
                  1240
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  â39
                  156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Total proposed receipts
                  
                  â39
                  â2,384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  414,170
                  437,633
                  460,205
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  453,773
                  484,440
                  535,809
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â3,314
                  â3,441
                  â3,032
               
               
                  2101
                  Federal Supplementary Medical Insurance Trust Fund
                  â315,747
                  â351,477
                  â368,115
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â402
                  â413
                  â634
               
               
                  2101
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  â94,837
                  â82,347
                  â90,808
               
               
                  2134
                  Federal Supplementary Medical Insurance Trust Fund
                  7,632
                  28,862
                  8,453
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Total current law appropriations
                  â406,668
                  â408,816
                  â454,136
               
               
                  
                  Proposed:
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  2,523
               
               
                  2201
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  974
               
               
                  2201
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  â918
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  â2,523
               
               
                  2203
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â20
                  
               
               
                  2234
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  
                  2,308
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Total proposed appropriations
                  
                  â20
                  2,364
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total appropriations
                  â406,668
                  â408,836
                  â451,772
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  47,105
                  75,604
                  84,037
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  310,129
                  321,129
                  357,948
               
               
                  0002
                  Transfer to Medicaid for payment of SMI premiums
                  652
                  1,000
                  1,054
               
               
                  0003
                  HIT Incentive Payments
                  435
                  
                  
               
               
                  0004
                  Administration, SMI
                  2,825
                  3,663
                  3,213
               
               
                  0005
                  Quality Improvement Organizations, SMI
                  502
                  252
                  472
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  314,543
                  326,044
                  362,687
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  314,543
                  326,044
                  362,687
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  6
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  1033
                  Recoveries of prior year paid obligations
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  7
                  
                  6
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  3,314
                  3,441
                  3,032
               
               
                  1130
                  Appropriations permanently reduced
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  3,314
                  3,435
                  3,032
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  315,747
                  351,477
                  368,115
               
               
                  1234
                  Appropriations precluded from obligation
                  â7,632
                  â28,862
                  â8,453
               
               
                  1236
                  Appropriations applied to repay debt
                  â613
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  307,502
                  322,615
                  359,662
               
               
                  
                  Borrowing authority, mandatory:
               
               
                  1400
                  Borrowing authority
                  3,720
                  
                  
               
               
                  1900
                  Budget authority (total)
                  314,536
                  326,050
                  362,694
               
               
                  1930
                  Total budgetary resources available
                  314,543
                  326,050
                  362,700
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  6
                  13
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  25,829
                  26,303
                  26,434
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  
                  268
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  314,543
                  326,044
                  362,687
               
               
                  3020
                  Outlays (gross)
                  â314,067
                  â326,181
                  â362,834
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  26,303
                  26,434
                  26,287
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  25,829
                  26,571
                  26,434
               
               
                  3200
                  Obligated balance, end of year
                  26,303
                  26,434
                  26,287
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,314
                  3,435
                  3,032
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,806
                  2,030
                  2,026
               
               
                  4011
                  Outlays from discretionary balances
                  2,371
                  1,455
                  1,060
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  4,177
                  3,485
                  3,086
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  311,222
                  322,615
                  359,662
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  287,121
                  298,783
                  330,446
               
               
                  4101
                  Outlays from mandatory balances
                  22,769
                  23,913
                  29,302
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  309,890
                  322,696
                  359,748
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â5
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  311,222
                  322,615
                  359,662
               
               
                  4170
                  Outlays, net (mandatory)
                  309,885
                  322,696
                  359,748
               
               
                  4180
                  Budget authority, net (total)
                  314,536
                  326,050
                  362,694
               
               
                  4190
                  Outlays, net (total)
                  314,062
                  326,181
                  362,834
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  63,336
                  70,589
                  95,789
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  70,589
                  95,789
                  102,490
               
               
                  5080
                  Outstanding debt, SOY
                  â3,289
                  â6,396
                  â6,396
               
               
                  5081
                  Outstanding debt, EOY
                  â6,396
                  â6,396
                  â6,396
               
               
                  5082
                  Borrowing
                  â3,720
                  
                  
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  314,536
                  326,050
                  362,694
               
               
                  
                  Outlays
                  314,062
                  326,181
                  362,834
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  20
                  â3,282
               
               
                  
                  Outlays
                  
                  20
                  â3,282
               
               
                  Total:
               
               
                  
                  Budget Authority
                  314,536
                  326,070
                  359,412
               
               
                  
                  Outlays
                  314,062
                  326,201
                  359,552
               
               
                  
                     
                  
               
            
         
      
      
         The Supplementary Medical Insurance (SMI) program is a voluntary program that affords protection against the costs of physician
            care and certain other medical services. The program also covers treatment of end-stage renal disease for eligible enrollees.
            SMI costs are generally financed by premium payments from enrollees and contributions from the general revenues.
         
         In addition, the Budget includes a package of targeted Medicare proposals designed to improve drug pricing and payment, address
            opioids, eliminate wasteful Federal spending and spending on government-imposed provider burdens, address fraud and abuse,
            and reform the Medicare appeals process.
         
      
      Status of Funds (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Unexpended balance, start of year:
               
               
                  0100
                  Balance, start of year
                  62,774
                  68,008
                  96,789
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0999
                  Total balance, start of year
                  62,774
                  68,008
                  96,789
               
               
                  
                  Cash income during the year:
               
               
                  
                  Current law:
               
               
                  
                  Receipts:
               
               
                  1110
                  Fee on Branded Prescription Pharmaceutical Manufacturers and Importers, SMI
                  4,147
                  5,997
                  2,826
               
               
                  1130
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  4,936
                  5,240
                  5,656
               
               
                  1130
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  11,072
                  11,938
                  12,558
               
               
                  1130
                  Basic Premium, Medicare Advantage, FSMI Trust Fund
                  457
                  492
                  553
               
               
                  1130
                  Medicare Refunds, SMI
                  5,011
                  5,242
                  5,292
               
               
                  1130
                  Affordable Care Act Medicare Shared Savings Models, SMI
                  1
                  3
                  3
               
               
                  1130
                  Premiums Collected for the Aged, FSMI Fund
                  67,357
                  78,021
                  84,296
               
               
                  1130
                  Premiums Collected for the Disabled, FSMI Fund
                  12,326
                  12,461
                  12,648
               
               
                  1130
                  Federal Supplementary Medical Insurance Trust Fund
                  5
                  
                  
               
               
                  1130
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  380
                  
                  
               
               
                  1150
                  Interest Received by Trust Fund, FSMI Fund
                  2,262
                  1,227
                  1,210
               
               
                  1150
                  Other Proprietary Interest from the Public, FSMI Fund
                  7
                  3
                  3
               
               
                  1150
                  Interest, Medicare Prescription Drug Account, FSMI
                  53
                  22
                  15
               
               
                  1160
                  Federal Contributions, FSMI Fund
                  227,879
                  244,685
                  263,711
               
               
                  1160
                  Federal Contribution, State Low-income Determinations, Prescription Drug Account, FSMI
                  
                  3
                  4
               
               
                  1160
                  Federal Contribution for Admin. Contribution for Admin. Costs, Prescription Drug Account, FSMI
                  â131
                  422
                  642
               
               
                  1160
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  78,791
                  71,915
                  73,171
               
               
                  1160
                  Miscellaneous Federal Payments, Federal Supplementary Medical Insurance Trust Fund
                  2
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Income under present law
                  414,555
                  437,672
                  462,589
               
               
                  
                  Proposed:
               
               
                  
                  Offsetting receipts (proprietary):
               
               
                  1230
                  Premiums Collected for Medicare Prescription Drug Account, FSMI
                  
                  
                  922
               
               
                  1230
                  Payments from States, Medicare Prescription Drug Account, FSMI
                  
                  
                  â160
               
               
                  1230
                  Premiums Collected for the Aged, FSMI Fund
                  
                  
                  â711
               
               
                  1230
                  Premiums Collected for the Disabled, FSMI Fund
                  
                  
                  â107
               
               
                  
                  Offsetting governmental receipts:
               
               
                  1260
                  Federal Contributions, FSMI Fund
                  
                  
                  â2,484
               
               
                  1260
                  Federal Contributions for Benefits, Prescription Drug Account, SMI
                  
                  â39
                  156
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1299
                  Income proposed
                  
                  â39
                  â2,384
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total cash income
                  414,555
                  437,633
                  460,205
               
               
                  
                  Cash outgo during year:
               
               
                  
                  Current law:
               
               
                  2100
                  Federal Supplementary Medical Insurance Trust Fund [009â38â8004â0]
                  â314,067
                  â326,181
                  â362,834
               
               
                  2100
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund [009â38â8308â0]
                  â95,254
                  â82,645
                  â91,245
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2199
                  Outgo under current law
                  â409,321
                  â408,826
                  â454,079
               
               
                  
                  Proposed:
               
               
                  2200
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â20
                  3,282
               
               
                  2200
                  Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund
                  
                  
                  â918
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2299
                  Outgo under proposed legislation
                  
                  â20
                  2,364
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2999
                  Total cash outgo (-)
                  â409,321
                  â408,846
                  â451,715
               
               
                  
                  Surplus or deficit::
               
               
                  3110
                  Excluding interest
                  2,912
                  27,535
                  7,262
               
               
                  3120
                  Interest
                  2,322
                  1,252
                  1,228
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3199
                  Subtotal, surplus or deficit
                  5,234
                  28,787
                  8,490
               
               
                  3220
                  Federal Supplementary Medical Insurance Trust Fund
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3299
                  Total adjustments
                  
                  â6
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3999
                  Total change in fund balance
                  5,234
                  28,781
                  8,490
               
               
                  
                  Unexpended balance, end of year::
               
               
                  4100
                  Uninvested balance (net), end of year
                  â2,581
                  1,000
                  2,789
               
               
                  4200
                  Federal Supplementary Medical Insurance Trust Fund
                  70,589
                  95,789
                  102,490
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4999
                  Total balance, end of year
                  68,008
                  96,789
                  105,279
               
               
                  
                     
                  
               
            
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  1
                  1
               
               
                  41.0
                  Payment for Quality Improvement Organization (QIO) activity
                  502
                  252
                  472
               
               
                  42.0
                  Insurance claims and indemnities
                  310,781
                  322,129
                  359,002
               
               
                  94.0
                  Financial transfers
                  3,260
                  3,662
                  3,212
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  314,543
                  326,044
                  362,687
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  314,543
                  326,044
                  362,687
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  8
                  8
               
               
                  
                     
                  
               
            
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, not subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â2â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â2,523
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  
                  2,523
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Federal Supplementary Medical Insurance Trust Fund                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â4â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Benefit payments, SMI
                  
                  
                  â3,302
               
               
                  0004
                  Administration, SMI
                  
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  20
                  â3,282
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  20
                  â3,282
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  â974
               
               
                  1203
                  Appropriation (previously unavailable)
                  
                  20
                  
               
               
                  1234
                  Appropriations precluded from obligation
                  
                  
                  â2,308
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  20
                  â3,282
               
               
                  1900
                  Budget authority (total)
                  
                  20
                  â3,282
               
               
                  1930
                  Total budgetary resources available
                  
                  20
                  â3,282
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  20
                  â3,282
               
               
                  3020
                  Outlays (gross)
                  
                  â20
                  3,282
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  20
                  â3,282
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  20
                  â3,282
               
               
                  4180
                  Budget authority, net (total)
                  
                  20
                  â3,282
               
               
                  4190
                  Outlays, net (total)
                  
                  20
                  â3,282
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8004â4â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  42.0
                  Insurance claims and indemnities
                  
                  
                  â3,302
               
               
                  94.0
                  Financial transfers
                  
                  20
                  20
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  20
                  â3,282
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  20
                  â3,282
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  88,263
                  82,340
                  85,996
               
               
                  0002
                  Administrative Costs
                  405
                  422
                  642
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  88,668
                  82,762
                  86,638
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  88,668
                  82,762
                  86,638
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  2
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  402
                  413
                  634
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  94,837
                  82,347
                  90,808
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â6,569
                  
                  
               
               
                  1900
                  Budget authority (total)
                  88,670
                  82,760
                  91,442
               
               
                  1930
                  Total budgetary resources available
                  88,670
                  82,762
                  91,442
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  2
                  
                  4,804
               
               
                  
                  Special and non-revolving trust funds:
               
               
                  1952
                  Expired unobligated balance, start of year
                  41
                  3
                  3
               
               
                  1953
                  Expired unobligated balance, end of year
                  3
                  3
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  14,638
                  8,402
                  8,546
               
               
                  3001
                  Adjustments to unpaid obligations, brought forward, Oct 1
                  
                  27
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  88,668
                  82,762
                  86,638
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  420
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â95,254
                  â82,645
                  â91,245
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â70
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,402
                  8,546
                  3,939
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â14,110
                  â7,541
                  â7,541
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  6,569
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â7,541
                  â7,541
                  â7,541
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  528
                  888
                  1,005
               
               
                  3200
                  Obligated balance, end of year
                  861
                  1,005
                  â3,602
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  402
                  413
                  634
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  246
                  221
                  319
               
               
                  4011
                  Outlays from discretionary balances
                  2
                  72
                  113
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  248
                  293
                  432
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4033
                  Non-Federal sources
                  â380
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  380
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  402
                  413
                  634
               
               
                  4080
                  Outlays, net (discretionary)
                  â132
                  293
                  432
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  88,268
                  82,347
                  90,808
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  80,633
                  74,212
                  81,405
               
               
                  4101
                  Outlays from mandatory balances
                  14,373
                  8,140
                  9,408
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  95,006
                  82,352
                  90,813
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  6,569
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  95,239
                  82,760
                  91,442
               
               
                  4190
                  Outlays, net (total)
                  94,874
                  82,645
                  91,245
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  95,239
                  82,760
                  91,442
               
               
                  
                  Outlays
                  94,874
                  82,645
                  91,245
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  918
               
               
                  
                  Outlays
                  
                  
                  918
               
               
                  Total:
               
               
                  
                  Budget Authority
                  95,239
                  82,760
                  92,360
               
               
                  
                  Outlays
                  94,874
                  82,645
                  92,163
               
               
                  
                     
                  
               
            
         
      
      
         Since January 2006, Medicare beneficiaries have had the opportunity to enroll in a comprehensive voluntary prescription drug
            benefit. The Budget includes a package of proposals designed to modernize the Part D benefit by realigning incentives and
            enhancing benefit management.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.2
                  Other services from non-Federal sources
                  405
                  422
                  642
               
               
                  42.0
                  Insurance claims and indemnities
                  88,263
                  82,340
                  85,996
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  88,668
                  82,762
                  86,638
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  88,668
                  82,762
                  86,638
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â0â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Medicare Prescription Drug Account, Federal Supplementary Insurance Trust Fund                                           
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â8308â4â7â571
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Prescription Drug Benefits
                  
                  
                  918
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  918
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 42.0)
                  
                  
                  918
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  
                  
                  918
               
               
                  1900
                  Budget authority (total)
                  
                  
                  918
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  918
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  918
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â918
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  918
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  918
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  918
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  918
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Administration for Children and Families                                                                                 
            
         Federal Funds
         Temporary Assistance for Needy Families                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  16,432
                  16,433
                  16,433
               
               
                  0002
                  Territories - family assistance grants
                  78
                  78
                  78
               
               
                  0006
                  Tribal work programs
                  8
                  8
                  8
               
               
                  0009
                  Healthy marriage and responsible fatherhood grants
                  144
                  148
                  150
               
               
                  0010
                  Evaluation Funding and What Works Clearinghouse
                  44
                  45
                  45
               
               
                  0011
                  Census Bureau Research
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  16,716
                  16,722
                  16,724
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  16,739
                  16,739
                  16,739
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  16,737
                  16,737
                  16,739
               
               
                  1930
                  Total budgetary resources available
                  16,737
                  16,737
                  16,739
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â21
                  â15
                  â15
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  7,037
                  7,772
                  8,163
               
               
                  3010
                  New obligations, unexpired accounts
                  16,716
                  16,722
                  16,724
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  5
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â15,974
                  â16,331
                  â16,511
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  7,772
                  8,163
                  8,376
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7,037
                  7,772
                  8,163
               
               
                  3200
                  Obligated balance, end of year
                  7,772
                  8,163
                  8,376
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  16,737
                  16,737
                  16,739
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  11,468
                  12,072
                  12,073
               
               
                  4101
                  Outlays from mandatory balances
                  4,506
                  4,259
                  4,438
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  15,974
                  16,331
                  16,511
               
               
                  4180
                  Budget authority, net (total)
                  16,737
                  16,737
                  16,739
               
               
                  4190
                  Outlays, net (total)
                  15,974
                  16,331
                  16,511
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  16,737
                  16,737
                  16,739
               
               
                  
                  Outlays
                  15,974
                  16,331
                  16,511
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,602
               
               
                  
                  Outlays
                  
                  
                  â1,155
               
               
                  Total:
               
               
                  
                  Budget Authority
                  16,737
                  16,737
                  15,137
               
               
                  
                  Outlays
                  15,974
                  16,331
                  15,356
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funding for the Temporary Assistance for Needy Families (TANF) block grant and related activities authorized
            by the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the Deficit Reduction
            Act of 2005 (P.L. 109â171). The Consolidated Appropriations Act, 2017 (P.L. 115â31) authorized TANF for fiscal years 2017
            and 2018. The Budget proposes to create a comprehensive demonstration opportunity for states to grow capacity across public
            safety net benefit programs to reduce dependency; continue and modify TANF to refocus the program on the core principle of
            promoting employment; continue the 0.33 percent set-aside for TANF evaluation, research, and technical assistance; and to
            reduce the authorized funding for TANF Family Assistance Grants to States, territories, and tribes by 10 percent.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  6
                  7
                  7
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  8
                  8
                  8
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  71
                  68
                  67
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  7
                  7
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  
                  
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  16,629
                  16,634
                  16,637
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  16,716
                  16,722
                  16,724
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  105
                  106
                  106
               
               
                  
                     
                  
               
            
         
      
         Temporary Assistance for Needy Families                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1552â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State family assistance grant
                  
                  
                  â1,594
               
               
                  0002
                  Territories - family assistance grants
                  
                  
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  â1,602
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,602
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,602
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,602
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,155
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â447
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â447
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,602
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,155
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,602
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,155
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Contingency Fund                                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency Fund for State Welfare Programs
                  608
                  608
                  608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  608
                  608
                  608
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  608
                  608
                  608
               
               
                  1900
                  Budget authority (total)
                  608
                  608
                  608
               
               
                  1930
                  Total budgetary resources available
                  608
                  608
                  608
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  72
                  113
                  95
               
               
                  3010
                  New obligations, unexpired accounts
                  608
                  608
                  608
               
               
                  3020
                  Outlays (gross)
                  â567
                  â626
                  â609
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  113
                  95
                  94
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  72
                  113
                  95
               
               
                  3200
                  Obligated balance, end of year
                  113
                  95
                  94
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  608
                  608
                  608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  529
                  545
                  545
               
               
                  4101
                  Outlays from mandatory balances
                  38
                  81
                  64
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  567
                  626
                  609
               
               
                  4180
                  Budget authority, net (total)
                  608
                  608
                  608
               
               
                  4190
                  Outlays, net (total)
                  567
                  626
                  609
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  608
                  608
                  608
               
               
                  
                  Outlays
                  567
                  626
                  609
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â608
               
               
                  
                  Outlays
                  
                  
                  â545
               
               
                  Total:
               
               
                  
                  Budget Authority
                  608
                  608
                  
               
               
                  
                  Outlays
                  567
                  626
                  64
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to eliminate funding for the Contingency Fund.
      
         Contingency Fund                                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1522â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Contingency fund
                  
                  
                  â608
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 41.0)
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â608
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â608
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â608
               
               
                  3020
                  Outlays (gross)
                  
                  
                  545
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â63
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â63
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â608
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â545
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â608
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â545
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Payments to states for child support enforcement and family support programsFor carrying out, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI of the Social Security Act and the Act
            of July 5, 1960 (24 U.S.C. 321â329), $2,922,247,000, to remain available until expended; and for such purposes for the first quarter of fiscal year 2020, $1,400,000,000, to remain available until expended.
      For carrying out, after May 31 of the current fiscal year, except as otherwise provided, titles I, IV-D, X, XI, XIV, and XVI
            of the Social Security Act and the Act of July 5, 1960 (24 U.S.C. 321â329), for the last 3 months of the current fiscal year
            for unanticipated costs, incurred for the current fiscal year, such sums as may be necessary.
      Note.âA full-year 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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  3,826
                  3,901
                  3,890
               
               
                  0002
                  Child support incentive payments
                  572
                  581
                  589
               
               
                  0003
                  Access and visitation grants
                  10
                  10
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  4,408
                  4,492
                  4,489
               
               
                  0102
                  Payments to territories
                  33
                  33
                  33
               
               
                  0103
                  Repatriation
                  3
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Subtotal, other payments
                  36
                  34
                  34
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  4,444
                  4,526
                  4,523
               
               
                  0801
                  Offset obligations (CSE grants to States)
                  10
                  13
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  4,454
                  4,539
                  4,536
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  35
                  22
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  187
                  200
                  200
               
               
                  1029
                  Other balances withdrawn to Treasury
                  â32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  155
                  235
                  222
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  3,011
                  2,926
                  2,922
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  1,300
                  1,400
                  1,400
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  23
                  
                  13
               
               
                  1900
                  Budget authority (total)
                  4,334
                  4,326
                  4,335
               
               
                  1930
                  Total budgetary resources available
                  4,489
                  4,561
                  4,557
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  35
                  22
                  21
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,093
                  1,262
                  1,395
               
               
                  3010
                  New obligations, unexpired accounts
                  4,454
                  4,539
                  4,536
               
               
                  3020
                  Outlays (gross)
                  â4,098
                  â4,206
                  â4,271
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â187
                  â200
                  â200
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,262
                  1,395
                  1,460
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,093
                  1,262
                  1,395
               
               
                  3200
                  Obligated balance, end of year
                  1,262
                  1,395
                  1,460
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  4,334
                  4,326
                  4,335
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  3,663
                  3,676
                  3,686
               
               
                  4101
                  Outlays from mandatory balances
                  435
                  530
                  585
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  4,098
                  4,206
                  4,271
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â23
                  
                  â13
               
               
                  4180
                  Budget authority, net (total)
                  4,311
                  4,326
                  4,322
               
               
                  4190
                  Outlays, net (total)
                  4,075
                  4,206
                  4,258
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  4,311
                  4,326
                  4,322
               
               
                  
                  Outlays
                  4,075
                  4,206
                  4,258
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  76
               
               
                  
                  Outlays
                  
                  
                  76
               
               
                  Total:
               
               
                  
                  Budget Authority
                  4,311
                  4,326
                  4,398
               
               
                  
                  Outlays
                  4,075
                  4,206
                  4,334
               
               
                  
                     
                  
               
            
         
      
      
         This account provides for payments to States for child support enforcement and other family support programs, including access
            and visitation programs for families. The Federal share of child support collections is returned to the Treasury in a receipt
            account. The Budget improves establishment and enforcement procedures by closing loopholes and improving Federal processes.
            Proposals target systems modernization, increased collections, expanded distribution, and improved program efficiency.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  41.0
                  Direct obligations: Grants, subsidies, and contributions
                  4,444
                  4,526
                  4,523
               
               
                  99.0
                  Reimbursable obligations
                  10
                  13
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  4,454
                  4,539
                  4,536
               
               
                  
                     
                  
               
            
         
      
         Payments to States for Child Support Enforcement and Family Support Programs                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  State child support administrative costs
                  
                  
                  76
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0091
                  Subtotal, child support enforcement
                  
                  
                  76
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  
                  76
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  76
               
               
                  1900
                  Budget authority (total)
                  
                  
                  76
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  76
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  76
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â76
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  76
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  76
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  76
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  76
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1501â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  120
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  â44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  
                  76
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  76
               
               
                  
                     
                  
               
            
         
      
         Low income home energy assistance
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  LIHEAP Block Grant
                  3,394
                  3,367
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  3
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  4
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  3,390
                  3,367
                  
               
               
                  1930
                  Total budgetary resources available
                  3,394
                  3,367
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,229
                  1,421
                  1,517
               
               
                  3010
                  New obligations, unexpired accounts
                  3,394
                  3,367
                  
               
               
                  3020
                  Outlays (gross)
                  â3,183
                  â3,271
                  â1,079
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,421
                  1,517
                  438
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,229
                  1,421
                  1,517
               
               
                  3200
                  Obligated balance, end of year
                  1,421
                  1,517
                  438
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  3,390
                  3,367
                  
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,170
                  2,155
                  
               
               
                  4011
                  Outlays from discretionary balances
                  1,013
                  1,116
                  1,079
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  3,183
                  3,271
                  1,079
               
               
                  4180
                  Budget authority, net (total)
                  3,390
                  3,367
                  
               
               
                  4190
                  Outlays, net (total)
                  3,183
                  3,271
                  1,079
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1502â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  3
                  3
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  3,391
                  3,364
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  3,394
                  3,367
                  
               
               
                  
                     
                  
               
            
         
      
         Refugee and entrant assistanceFor necessary expenses for refugee and entrant assistance activities authorized by section 414 of the Immigration and Nationality
            Act and section 501 of the Refugee Education Assistance Act of 1980, and for carrying out section 462 of the Homeland Security
            Act of 2002, section 235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, the Trafficking
            Victims Protection Act of 2000 ("TVPA"), and the Torture Victims Relief Act of 1998, $1,242,311,000, of which $1,212,821,000 shall remain available through September 30, 2021 for carrying out such sections 414, 501, 462, and 235: Provided, That amounts available under this heading to carry out the TVPA shall also be available for research and evaluation with respect to activities under those authorities: Provided further, That the limitation in section 204 of this Act regarding transfers increasing any appropriation shall apply to transfers
            to appropriations under this heading by substituting "10 percent" for "3 percent": Provided further, That funds made available under this heading in this and prior Acts shall be available to reimburse other Federal agencies
            for the costs of making land or facilities available for temporary housing of unaccompanied alien children as defined in section
            235 of the William Wilberforce Trafficking Victims Protection Reauthorization Act of 2008, if the Secretary determines that
            such housing is needed for purposes of carrying out such section 235 and section 462 of the Homeland Security Act of 2002:
            Provided further, That such funds may be used for construction and improvements to property and demolition as necessary for this purpose: Provided further, That other Federal agencies are hereby authorized for the current fiscal year to make land or facilities available for the
            purposes described in the third proviso, and to retain and use such reimbursements to cover costs incurred. 
      In addition, $200,000,000 shall be available to carry out such sections 235 and 462: (1) if, at any point during this fiscal
               year the Secretary has transferred from other accounts to this account an amount equal to at least 3 percent of the amount
               appropriated to this account in the first paragraph, and has determined that such transfers are needed to support caseloads
               that are higher than average; (2) if the Secretary has determined that, in each of two consecutive months during this fiscal
               year, the number of unaccompanied alien children transferred to the custody of the Secretary pursuant to such section 235
               has increased from the number so transferred in the previous month, and that, in the second of such months, the number so
               transferred is at least 120 percent of the number so transferred in the first of such months; and (3) if the Secretary has
               determined that, for each of two non-overlapping seven-day periods during the two-month period, the average number of unaccompanied
               alien children in the custody of the Office of Refugee Resettlement who are discharged in a day is less than 1.2 percent of
               the average number of such children who are in such custody in a day.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Refugee and entrant assistance
                  705
                  692
                  514
               
               
                  0002
                  Assistance for treatment of torture victims
                  11
                  11
                  11
               
               
                  0003
                  Unaccompanied Children
                  1,395
                  942
                  798
               
               
                  0005
                  Trafficking Victims program
                  11
                  19
                  19
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,122
                  1,664
                  1,342
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  98
                  190
                  190
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0125]
                  300
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â1536]
                  6
                  
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0350]
                  2
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  72
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  478
                  190
                  190
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Base Appropriation
                  1,676
                  1,664
                  1,242
               
               
                  1100
                  UAC Contingency Fund
                  
                  
                  100
               
               
                  1121
                  Appropriations transferred from other acct [075â9912]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1536]
                  39
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1700]
                  1
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0142]
                  4
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â1362]
                  8
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0943]
                  14
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0350]
                  14
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â9915]
                  72
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0140]
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,833
                  1,664
                  1,342
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  8
                  
                  
               
               
                  1900
                  Budget authority (total)
                  1,841
                  1,664
                  1,342
               
               
                  1930
                  Total budgetary resources available
                  2,319
                  1,854
                  1,532
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â7
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  190
                  190
                  190
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  996
                  1,003
                  888
               
               
                  3010
                  New obligations, unexpired accounts
                  2,122
                  1,664
                  1,342
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â2,007
                  â1,779
                  â1,442
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â72
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,003
                  888
                  788
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  996
                  1,003
                  888
               
               
                  3200
                  Obligated balance, end of year
                  1,003
                  888
                  788
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,841
                  1,664
                  1,342
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,260
                  1,082
                  872
               
               
                  4011
                  Outlays from discretionary balances
                  747
                  697
                  570
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,007
                  1,779
                  1,442
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â8
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  1,833
                  1,664
                  1,342
               
               
                  4190
                  Outlays, net (total)
                  1,999
                  1,779
                  1,442
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds to States and non-governmental organizations to administer the refugee and entrant assistance
            programs. Funds support cash and medical assistance and social services for refugees, asylees, and other arrivals eligible
            for refugee benefits. The account also includes funding for the rehabilitation of victims of torture and human trafficking
            and for the care and placement of unaccompanied alien children.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  11
                  9
                  10
               
               
                  11.7
                  Military personnel
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  11
                  10
                  11
               
               
                  12.1
                  Civilian personnel benefits
                  4
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  4
                  4
                  4
               
               
                  25.1
                  Advisory and assistance services
                  227
                  229
                  80
               
               
                  25.2
                  Other services from non-Federal sources
                  4
                  2
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  37
                  23
                  23
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,835
                  1,393
                  1,219
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,122
                  1,664
                  1,342
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1503â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  86
                  89
                  89
               
               
                  1101
                  Direct military average strength employment
                  7
                  11
                  11
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable FamiliesFor carrying out, except as otherwise provided, section 436 of the Social Security Act, $345,000,000 and, for carrying out, except as otherwise provided, section 437 of such Act, $59,765,000.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  343
                  343
                  364
               
               
                  0002
                  Research, training and technical assistance
                  8
                  7
                  8
               
               
                  0003
                  State court improvement activities
                  30
                  11
                  32
               
               
                  0004
                  Family Connection Grants
                  2
                  1
                  1
               
               
                  0005
                  Personal Responsibility Education (PREP)
                  70
                  17
                  9
               
               
                  0006
                  Abstinence Education
                  63
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  516
                  379
                  414
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  25
                  28
                  10
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  29
                  28
                  10
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  59
                  60
               
               
                  1130
                  Appropriations permanently reduced
                  
                  â20
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  60
                  39
                  60
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  495
                  345
                  345
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â34
                  â23
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  461
                  322
                  345
               
               
                  1900
                  Budget authority (total)
                  521
                  361
                  405
               
               
                  1930
                  Total budgetary resources available
                  550
                  389
                  415
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â6
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  28
                  10
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  563
                  595
                  478
               
               
                  3010
                  New obligations, unexpired accounts
                  516
                  379
                  414
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  2
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â465
                  â496
                  â434
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â3
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â18
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  595
                  478
                  458
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  563
                  595
                  478
               
               
                  3200
                  Obligated balance, end of year
                  595
                  478
                  458
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  60
                  39
                  60
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  18
                  12
                  21
               
               
                  4011
                  Outlays from discretionary balances
                  36
                  39
                  28
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  54
                  51
                  49
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  461
                  322
                  345
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  90
                  95
                  109
               
               
                  4101
                  Outlays from mandatory balances
                  321
                  350
                  276
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  411
                  445
                  385
               
               
                  4180
                  Budget authority, net (total)
                  521
                  361
                  405
               
               
                  4190
                  Outlays, net (total)
                  465
                  496
                  434
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  521
                  361
                  405
               
               
                  
                  Outlays
                  465
                  496
                  434
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  190
               
               
                  
                  Outlays
                  
                  
                  17
               
               
                  Total:
               
               
                  
                  Budget Authority
                  521
                  361
                  595
               
               
                  
                  Outlays
                  465
                  496
                  451
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funds for a broad range of child welfare services, including family preservation and support services
            and grants to increase the well-being of and improve the permanency outcomes for children affected by substance abuse, through
            Promoting Safe and Stable Families. The Budget includes a proposal to expand the Regional Partnership Grants program, a five-year
            reauthorization of Promoting Safe and Stable Families, and a one-year reauthorization, with modifications, of Abstinence Education
            and the Personal Responsibility Education Program (PREP).
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  12
                  7
                  7
               
               
                  25.3
                  Other goods and services from Federal sources
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  501
                  369
                  404
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  516
                  379
                  414
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  11
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Promoting Safe and Stable Families                                                                                       
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Grants to States and Tribes
                  
                  
                  40
               
               
                  0005
                  PREP
                  
                  
                  75
               
               
                  0006
                  Abstinence Education
                  
                  
                  75
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  190
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  190
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  190
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  190
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  173
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  173
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  190
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  17
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  190
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  17
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  10
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  178
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  190
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1512â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Mandatory child care
                  1,178
                  1,178
                  1,178
               
               
                  0002
                  Matching child care
                  1,689
                  1,662
                  1,651
               
               
                  0003
                  Child Care Training and technical assistance
                  14
                  15
                  15
               
               
                  0004
                  Child care tribal grants
                  58
                  58
                  58
               
               
                  0005
                  Child Care Research
                  4
                  4
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,943
                  2,917
                  2,917
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  27
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  2,917
                  2,917
                  2,917
               
               
                  1930
                  Total budgetary resources available
                  2,944
                  2,917
                  2,917
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,053
                  1,060
                  967
               
               
                  3010
                  New obligations, unexpired accounts
                  2,943
                  2,917
                  2,917
               
               
                  3020
                  Outlays (gross)
                  â2,905
                  â3,010
                  â2,943
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,060
                  967
                  941
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,053
                  1,060
                  967
               
               
                  3200
                  Obligated balance, end of year
                  1,060
                  967
                  941
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2,137
                  2,174
                  2,167
               
               
                  4101
                  Outlays from mandatory balances
                  768
                  836
                  776
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  2,905
                  3,010
                  2,943
               
               
                  4180
                  Budget authority, net (total)
                  2,917
                  2,917
                  2,917
               
               
                  4190
                  Outlays, net (total)
                  2,905
                  3,010
                  2,943
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  2,917
               
               
                  
                  Outlays
                  2,905
                  3,010
                  2,943
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  671
               
               
                  
                  Outlays
                  
                  
                  499
               
               
                  Total:
               
               
                  
                  Budget Authority
                  2,917
                  2,917
                  3,588
               
               
                  
                  Outlays
                  2,905
                  3,010
                  3,442
               
               
                  
                     
                  
               
            
         
      
      
         This account provides child care subsidies for low-income working families and was established by the Personal Responsibility
            and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            Since 2010, this account has been temporarily reauthorized by a series of Acts, most recently in the Consolidated Appropriations
            Act, 2017 (P.L. 115â31). The Budget increases funding for this account to ensure federal funding for key child care programs
            is maintained, given the effects of other Budget proposals on child care spending.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  7
                  7
                  18
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,935
                  2,909
                  2,898
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,943
                  2,917
                  2,917
               
               
                  
                     
                  
               
            
         
      
         Child Care Entitlement to States                                                                                         
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Matching child care
                  
                  
                  651
               
               
                  0003
                  Child Care Training and technical assistance
                  
                  
                  3
               
               
                  0004
                  Child care tribal grants
                  
                  
                  14
               
               
                  0005
                  Child Care Research
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  671
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  671
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  671
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  671
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â499
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  172
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  172
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  671
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  499
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  671
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  499
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1550â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  7
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  664
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  671
               
               
                  
                     
                  
               
            
         
      
         Payments to states for the child care and development block grantFor carrying out the Child Care and Development Block Grant Act of 1990 ("CCDBG Act"), $2,560,000,000 shall be used to supplement, not supplant State general revenue funds for child care assistance for low-income families: Provided, That technical assistance under section 658I(a)(3) of such Act may be provided directly, or through the use of contracts,
            grants, cooperative agreements, or interagency agreements: Provided further, That all funds made available to carry out section 418 of the Social Security Act (42 U.S.C. 618), including funds appropriated
            for that purpose in such section 418 or any other provision of law, shall be subject to the reservation of funds authority
            in paragraphs (4) and (5) of section 658O(a) of the CCDBG Act: Provided further, That none of the funds provided under this heading may be used to implement the national toll-free hotline
               under section 658L(b) of the CCDBG Act.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Child Care Block grant payments to States
                  2,845
                  2,827
                  2,547
               
               
                  0004
                  Child Care Research and evaluation fund
                  10
                  10
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,855
                  2,837
                  2,560
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  2,856
                  2,837
                  2,560
               
               
                  1930
                  Total budgetary resources available
                  2,856
                  2,837
                  2,560
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,071
                  1,122
                  1,109
               
               
                  3010
                  New obligations, unexpired accounts
                  2,855
                  2,837
                  2,560
               
               
                  3020
                  Outlays (gross)
                  â2,801
                  â2,850
                  â2,644
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,122
                  1,109
                  1,025
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,071
                  1,122
                  1,109
               
               
                  3200
                  Obligated balance, end of year
                  1,122
                  1,109
                  1,025
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  2,856
                  2,837
                  2,560
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  2,036
                  1,997
                  1,800
               
               
                  4011
                  Outlays from discretionary balances
                  765
                  853
                  844
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  2,801
                  2,850
                  2,644
               
               
                  4180
                  Budget authority, net (total)
                  2,856
                  2,837
                  2,560
               
               
                  4190
                  Outlays, net (total)
                  2,801
                  2,850
                  2,644
               
               
                  
                     
                  
               
            
         
      
      
         This program provides grants to States for child care subsidies for low-income working families and activities to improve
            child care quality.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1515â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.1
                  Advisory and assistance services
                  22
                  21
                  23
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  2,833
                  2,814
                  2,535
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,855
                  2,837
                  2,560
               
               
                  
                     
                  
               
            
         
      
         Social services block grant
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Social Services Block Grant
                  1,583
                  1,588
                  1,700
               
               
                  0002
                  Health Profession Opportunity Grants
                  79
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,662
                  1,588
                  1,700
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  32
                  31
                  22
               
               
                  1031
                  Other balances not available
                  
                  â9
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  32
                  22
                  22
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,785
                  1,700
                  1,700
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â123
                  â112
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  1,662
                  1,588
                  1,700
               
               
                  1930
                  Total budgetary resources available
                  1,694
                  1,610
                  1,722
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  31
                  22
                  22
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  480
                  468
                  435
               
               
                  3010
                  New obligations, unexpired accounts
                  1,662
                  1,588
                  1,700
               
               
                  3020
                  Outlays (gross)
                  â1,661
                  â1,621
                  â1,718
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  468
                  435
                  417
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  480
                  468
                  435
               
               
                  3200
                  Obligated balance, end of year
                  468
                  435
                  417
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  1,662
                  1,588
                  1,700
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1,313
                  1,318
                  1,411
               
               
                  4101
                  Outlays from mandatory balances
                  348
                  303
                  307
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  1,661
                  1,621
                  1,718
               
               
                  4180
                  Budget authority, net (total)
                  1,662
                  1,588
                  1,700
               
               
                  4190
                  Outlays, net (total)
                  1,661
                  1,621
                  1,718
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  1,662
                  1,588
                  1,700
               
               
                  
                  Outlays
                  1,661
                  1,621
                  1,718
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  â1,615
               
               
                  
                  Outlays
                  
                  
                  â1,408
               
               
                  Total:
               
               
                  
                  Budget Authority
                  1,662
                  1,588
                  85
               
               
                  
                  Outlays
                  1,661
                  1,621
                  310
               
               
                  
                     
                  
               
            
         
      
      
         The Budget proposes to reduce the authorized funding level for the Social Services Block Grant to $0. The account also provides
            funding for the Health Profession Opportunity Grants demonstration to provide education and training to Temporary Assistance
            for Needy Families recipients and other low income individuals for health care occupations in high demand. The Budget proposes
            extending the demonstration through FY 2019.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  1
                  
                  
               
               
                  25.1
                  Advisory and assistance services
                  13
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,648
                  1,588
                  1,700
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,662
                  1,588
                  1,700
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  8
                  
                  
               
               
                  
                     
                  
               
            
         
      
         Social Services Block Grant                                                                                              
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Health Profession Opportunity Grants
                  
                  
                  85
               
               
                  0003
                  Social Services Block Grant
                  
                  
                  â1,700
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  â1,615
               
               
                  1900
                  Budget authority (total)
                  
                  
                  â1,615
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  â1,615
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  3020
                  Outlays (gross)
                  
                  
                  1,408
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  
                  
                  â207
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3200
                  Obligated balance, end of year
                  
                  
                  â207
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  â1,615
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  â1,408
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  â1,615
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  â1,408
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  1
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  11
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  
                  â1,627
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  â1,615
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1534â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  8
               
               
                  
                     
                  
               
            
         
      
         Children and families services programsFor carrying out, except as otherwise provided, the Runaway and Homeless Youth Act, the Head Start Act, the Child Abuse Prevention
            and Treatment Act, sections 303 and 313 of the Family Violence Prevention and Services Act, the Native American Programs Act
            of 1974, title II of the Child Abuse Prevention and Treatment and Adoption Reform Act of 1978 (adoption opportunities), part
            B-1 of title IV and sections 429, 473A, 477(i), 1110, 1114A, and 1115 of the Social Security Act; and for necessary administrative
            expenses to carry out titles I, IV, V, X, XI, XIV, XVI, and XX-A of the Social Security Act, the Act of July 5, 1960, the
            Child Care and Development Block Grant Act of 1990, title IV of the Immigration and Nationality Act, and section 501 of the
            Refugee Education Assistance Act of 1980; $10,323,890,000, of which $37,943,000, to remain available through September 30, 2020, shall be for grants to States for adoption and legal guardianship incentive payments, as defined by section 473A of the
            Social Security Act and may be made for adoptions and legal guardianships completed before September 30, 2019: Provided, That $9,275,000,000 shall be for making payments under the Head Start Act: Provided further, That of the amount in the previous proviso, $21,905,000 shall be available for a cost of living adjustment notwithstanding section 640(a)(3)(A) of such Act: Provided
               further, That with respect to any subsequent continuing appropriations act, the previous proviso shall not be construed as
               an authority or condition under this Act and shall not apply in fiscal year 2020 to amounts provided by such a continuing
               appropriations act, notwithstanding any other law: Provided further, That of the amount identified in the first proviso, $14,000,000
               shall be available to supplement funding otherwise available for research, evaluation, and federal administrative costs: Provided further, That of the amount identified in the first proviso, $25,000,000 shall be available for allocation by the Secretary to supplement activities described in paragraphs (7)(B) and
            (9) of section 641(c) of the Head Start Act under the Designation Renewal System, established under the authority of sections 641(c)(7), 645A(b)(12) and 645A(d)
            of such Act: Provided further, That funds described in the preceding proviso shall not be included in the calculation of "base grant" in subsequent fiscal years, as such term is used in section 640(a)(7)(A)
            of such Act: Provided further, That notwithstanding any proviso under this heading in a prior Act making appropriations for a prior fiscal
               year (other than amounts that were designated by the Congress as an emergency requirement pursuant to a concurrent resolution
               on the budget or the Balanced Budget and Emergency Deficit Control Act of 1985), any amount issued through a grant for the
               purposes described in the following proviso shall be included in any calculation of "base grant", as such term is used in
               section 640(a)(7)(A) of such Act, that affects the allocation of funds appropriated in this Act: Provided further, That the
               previous proviso applies to funds granted for Early Head Start programs as described in section 645A of the Head Start Act,
               for conversion of Head Start services to Early Head Start services as described in section 645(a)(5)(A) of such Act, and for
               discretionary grants for high quality infant and toddler care through Early Head Start-Child Care Partnerships, to entities
               defined as eligible under section 645A(d) of such Act: Provided further, That the Secretary may reduce the reservation of
               funds under section 640(a)(2)(C) of such Act in lieu of reducing the reservation of funds under sections 640(a)(2)(B), 640(a)(2)(D),
               and 640(a)(2)(E) of such Act: Provided further, That $1,864,000 shall be for a human services case management system for federally declared disasters, to include a comprehensive national
            case management contract and Federal costs of administering the system: Provided further, That up to $2,000,000 shall be for improving the Public Assistance Reporting Information System, including grants to States
            to support data collection for a study of the system's effectiveness.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Head Start
                  9,554
                  9,190
                  9,275
               
               
                  0102
                  Preschool Development Grants
                  
                  498
                  
               
               
                  0103
                  Runaway and homeless youth (basic centers)
                  54
                  53
                  54
               
               
                  0104
                  Transitional living
                  48
                  48
                  48
               
               
                  0106
                  Education grants to reduce sexual abuse of runaway youth
                  17
                  17
                  17
               
               
                  0109
                  Child abuse State grants
                  25
                  25
                  25
               
               
                  0110
                  Child abuse discretionary activities
                  33
                  33
                  33
               
               
                  0111
                  Community-based child abuse prevention
                  40
                  39
                  40
               
               
                  0112
                  Child welfare services
                  268
                  267
                  269
               
               
                  0113
                  Child welfare training, research, or demonstration projects
                  18
                  18
                  18
               
               
                  0114
                  Adoption opportunities
                  39
                  39
                  39
               
               
                  0116
                  Adoption and Legal Guardianship Incentives
                  38
                  38
                  38
               
               
                  0117
                  Independent living education and training vouchers
                  43
                  43
                  43
               
               
                  0124
                  Native American programs
                  52
                  52
                  52
               
               
                  0125
                  Social services and income maintenance research
                  6
                  6
                  7
               
               
                  0128
                  ACF Federal administration
                  203
                  204
                  205
               
               
                  0131
                  Disaster human services case management
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0191
                  Direct program activities, subtotal
                  10,440
                  10,572
                  10,165
               
               
                  0301
                  Community services block grant
                  707
                  710
                  
               
               
                  0303
                  Rural community facilities
                  7
                  7
                  
               
               
                  0304
                  Community economic development
                  20
                  20
                  
               
               
                  0308
                  Domestic violence hotline
                  8
                  8
                  8
               
               
                  0309
                  Family violence prevention and services
                  151
                  150
                  151
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0391
                  Direct program activities, subtotal
                  893
                  895
                  159
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0400
                  Total, direct program
                  11,333
                  11,467
                  10,324
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  11,333
                  11,467
                  10,324
               
               
                  0801
                  Children and Families Services Programs (Reimbursable)
                  21
                  21
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  21
                  21
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  11,354
                  11,488
                  10,345
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  426
                  330
                  81
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  426
                  330
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â1503]
                  â6
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  420
                  330
                  81
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  11,294
                  11,218
                  10,324
               
               
                  1120
                  Appropriations transferred to other accts [075â1503]
                  â39
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  11,255
                  11,218
                  10,324
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  19
                  19
                  19
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  18
                  19
                  19
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  2
                  2
                  2
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  3
                  2
                  2
               
               
                  1900
                  Budget authority (total)
                  11,276
                  11,239
                  10,345
               
               
                  1930
                  Total budgetary resources available
                  11,696
                  11,569
                  10,426
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â12
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  330
                  81
                  81
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  7,620
                  8,269
                  7,693
               
               
                  3010
                  New obligations, unexpired accounts
                  11,354
                  11,488
                  10,345
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  8
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â10,623
                  â12,064
                  â10,978
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â90
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  8,269
                  7,693
                  7,060
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â8
                  â4
                  â4
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â4
                  â4
                  â4
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  7,612
                  8,265
                  7,689
               
               
                  3200
                  Obligated balance, end of year
                  8,265
                  7,689
                  7,056
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  11,273
                  11,237
                  10,343
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  4,064
                  4,732
                  4,357
               
               
                  4011
                  Outlays from discretionary balances
                  6,557
                  7,332
                  6,621
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  10,621
                  12,064
                  10,978
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â22
                  â22
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â22
                  â22
                  â22
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  1
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  11,255
                  11,218
                  10,324
               
               
                  4080
                  Outlays, net (discretionary)
                  10,599
                  12,042
                  10,956
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  3
                  2
                  2
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  
                  
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â2
                  â2
                  â2
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â1
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  
                  â2
                  â2
               
               
                  4180
                  Budget authority, net (total)
                  11,255
                  11,218
                  10,324
               
               
                  4190
                  Outlays, net (total)
                  10,599
                  12,040
                  10,954
               
               
                  
                     
                  
               
            
         
      
      
         The request totals $10.3 billion, including almost $9.3 billion for Head Start. This request discontinues funding for the
            Community Services Block Grant, Rural Community Facilities, and Community Economic Development.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  113
                  116
                  114
               
               
                  11.3
                  Other than full-time permanent
                  4
                  4
                  4
               
               
                  11.7
                  Military personnel
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  118
                  121
                  119
               
               
                  12.1
                  Civilian personnel benefits
                  36
                  36
                  36
               
               
                  21.0
                  Travel and transportation of persons
                  3
                  3
                  3
               
               
                  23.1
                  Rental payments to GSA
                  10
                  17
                  16
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  235
                  238
                  237
               
               
                  25.2
                  Other services from non-Federal sources
                  9
                  9
                  8
               
               
                  25.3
                  Other goods and services from Federal sources
                  49
                  46
                  43
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  2
                  2
               
               
                  26.0
                  Supplies and materials
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  10,870
                  10,992
                  9,857
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  11,333
                  11,467
                  10,324
               
               
                  99.0
                  Reimbursable obligations
                  21
                  21
                  21
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  11,354
                  11,488
                  10,345
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1536â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  1,149
                  1,142
                  1,122
               
               
                  1101
                  Direct military average strength employment
                  8
                  8
                  8
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  10
                  10
                  10
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Training and technical assistance
                  10
                  19
                  12
               
               
                  0002
                  Federal parent locator service
                  24
                  28
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  34
                  47
                  37
               
               
                  0801
                  Federal Parent Locator Service reimbursable
                  24
                  31
                  32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  24
                  31
                  32
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  58
                  78
                  69
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  12
                  12
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  14
                  12
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  37
                  37
                  37
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â3
                  â2
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  34
                  35
                  37
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  22
                  31
                  31
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  1
                  1
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  22
                  31
                  32
               
               
                  1900
                  Budget authority (total)
                  56
                  66
                  69
               
               
                  1930
                  Total budgetary resources available
                  70
                  78
                  69
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  12
                  
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  45
                  30
                  34
               
               
                  3010
                  New obligations, unexpired accounts
                  58
                  78
                  69
               
               
                  3020
                  Outlays (gross)
                  â71
                  â74
                  â83
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  30
                  34
                  20
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â6
                  â6
                  â6
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â6
                  â6
                  â6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  39
                  24
                  28
               
               
                  3200
                  Obligated balance, end of year
                  24
                  28
                  14
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  3
                  
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  56
                  66
                  69
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  36
                  46
                  47
               
               
                  4101
                  Outlays from mandatory balances
                  32
                  28
                  36
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  68
                  74
                  83
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â8
                  â9
                  â9
               
               
                  4123
                  Non-Federal sources
                  â14
                  â22
                  â22
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â22
                  â31
                  â31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  34
                  35
                  38
               
               
                  4170
                  Outlays, net (mandatory)
                  46
                  43
                  52
               
               
                  4180
                  Budget authority, net (total)
                  34
                  35
                  38
               
               
                  4190
                  Outlays, net (total)
                  49
                  43
                  52
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  
               
               
                  
                     
                  
               
            
         
      
      
         This account provides funding for research and technical assistance activities established by the Personal Responsibility
            and Work Opportunity Reconciliation Act of 1996 (P.L. 104â193), as amended by the Deficit Reduction Act of 2005 (P.L. 109â171).
            A set of proposals would provide additional access to the National Directory of New Hires. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  7
                  8
                  9
               
               
                  12.1
                  Civilian personnel benefits
                  2
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  1
                  2
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  8
                  8
                  7
               
               
                  25.3
                  Other goods and services from Federal sources
                  6
                  12
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  6
                  10
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  34
                  47
                  38
               
               
                  99.0
                  Reimbursable obligations
                  24
                  31
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  58
                  78
                  69
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  56
                  68
                  68
               
               
                  
                     
                  
               
            
         
      
         Children's Research and Technical Assistance                                                                             
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Federal Parent Locator Service reimbursable
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  3
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  3
               
               
                  1900
                  Budget authority (total)
                  
                  
                  3
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  3
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  3
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â3
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  3
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  3
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â3
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  25.1
                  Advisory and assistance services
                  
                  
                  1
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  3
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1553â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  2
               
               
                  
                     
                  
               
            
         
      
         Payments for foster care and permanencyFor carrying out, except as otherwise provided, title IV-E of the Social Security Act, $6,035,000,000.
      For carrying out, except as otherwise provided, title IV-E of the Social Security Act, for the first quarter of fiscal year 2020, $2,800,000,000.
      For carrying out, after May 31 of the current fiscal year, except as otherwise provided, section 474 of title IV-E of the
            Social Security Act, for the last 3 months of the current fiscal year for unanticipated costs, incurred for the current fiscal
            year, such sums as may be necessary.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  5,363
                  5,278
                  5,329
               
               
                  0002
                  Independent living
                  140
                  140
                  140
               
               
                  0004
                  Adoption assistance
                  2,706
                  2,861
                  3,063
               
               
                  0005
                  Guardianship
                  145
                  186
                  203
               
               
                  0006
                  Technical Assistance and Implementation Services for Tribal Programs
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  8,357
                  8,468
                  8,738
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  6,059
                  5,969
                  6,038
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  â1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  6,057
                  5,968
                  6,038
               
               
                  
                  Advance appropriations, mandatory:
               
               
                  1270
                  Advance appropriation
                  2,300
                  2,500
                  2,700
               
               
                  1900
                  Budget authority (total)
                  8,357
                  8,468
                  8,738
               
               
                  1930
                  Total budgetary resources available
                  8,357
                  8,468
                  8,738
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,113
                  1,611
                  1,813
               
               
                  3010
                  New obligations, unexpired accounts
                  8,357
                  8,468
                  8,738
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  69
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â7,712
                  â8,266
                  â8,597
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â216
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,611
                  1,813
                  1,954
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,113
                  1,611
                  1,813
               
               
                  3200
                  Obligated balance, end of year
                  1,611
                  1,813
                  1,954
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  8,357
                  8,468
                  8,738
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6,961
                  7,380
                  7,619
               
               
                  4101
                  Outlays from mandatory balances
                  751
                  886
                  978
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  7,712
                  8,266
                  8,597
               
               
                  4180
                  Budget authority, net (total)
                  8,357
                  8,468
                  8,738
               
               
                  4190
                  Outlays, net (total)
                  7,712
                  8,266
                  8,597
               
               
                  
                     
                  
               
            
         
      
      Summary of Budget Authority and Outlays (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Enacted/requested:
               
               
                  
                  Budget Authority
                  8,357
                  8,468
                  8,738
               
               
                  
                  Outlays
                  7,712
                  8,266
                  8,597
               
               
                  Legislative proposal, subject to PAYGO:
               
               
                  
                  Budget Authority
                  
                  
                  18
               
               
                  
                  Outlays
                  
                  
                  18
               
               
                  Total:
               
               
                  
                  Budget Authority
                  8,357
                  8,468
                  8,756
               
               
                  
                  Outlays
                  7,712
                  8,266
                  8,615
               
               
                  
                     
                  
               
            
         
      
      
         This account provides formula grants for Foster Care, Adoption Assistance, Guardianship Assistance Program, and the Chafee
            Foster Care Independence Program, as well as technical assistance and implementation services for tribal programs.
         
         Foster CareâThe proposed level will support eligible low-income children who must be placed outside the home. An average of 171,400 children
            per month are estimated to be served in FY 2019.
         
         Adoption AssistanceâThe proposed funding level will support subsidies for families adopting eligible low-income children with special needs.
            An average of 496,300 children per month are estimated to be served in FY 2019.
         
         Guardianship Assistance ProgramâThe proposed funding level will provide payments for relatives taking legal guardianship of eligible children who have been
            in foster care. An average of 35,600 children per month are estimated to be served in FY 2019.
         
         The Budget includes proposals to create the Child Welfare Flexible Funding Option for title IV-E agencies, create a performance
            incentive for achieving or exceeding Child and Family Services Reviews outcomes, reform the requirement for title IV-E agencies
            to calculate the savings in costs based on obsolete adoption program criteria, and authorize tribal titles IV-B and IV-E agencies
            to access certain information from the Federal Parent Locator Service. Additionally, the Budget includes the interaction effects
            from the proposal to eliminate SSBG funding, which increases costs in FCP due to State agencies shifting eligible expenses
            previously funded by SSBG to FCP.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  21.0
                  Travel and transportation of persons
                  
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  32
                  34
                  35
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  8,323
                  8,432
                  8,701
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  8,357
                  8,468
                  8,738
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â0â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  3
                  4
                  4
               
               
                  
                     
                  
               
            
         
      
         Payments for Foster Care and Permanency                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â1545â4â1â609
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Foster care
                  
                  
                  4
               
               
                  0004
                  Adoption assistance
                  
                  
                  13
               
               
                  0005
                  Guardianship
                  
                  
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 41.0)
                  
                  
                  18
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  
                  
                  18
               
               
                  1900
                  Budget authority (total)
                  
                  
                  18
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  18
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  18
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â18
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  18
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  18
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  18
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  18
               
               
                  
                     
                  
               
            
         
      
      
         
      
         Administration for Community Living                                                                                      
            
         Federal Funds
         aging and disability services programs
         (including transfer of funds)For carrying out, to the extent not otherwise provided, the Older Americans Act of 1965 ("OAA"), titles III and XXIX of the
            PHS Act, sections 1252 and 1253 of the PHS Act, section 119 of the Medicare Improvements for Patients and Providers Act of
            2008, title XX-B of the Social Security Act, the Developmental Disabilities Assistance and Bill of Rights Act, parts 2 and
            5 of subtitle D of title II of the Help America Vote Act of 2002, the Assistive Technology Act of 1998, title VII (and section 14 with respect to such title) of the Rehabilitation Act of 1973, and for Department-wide coordination of policy and program activities that assist individuals with disabilities, $1,781,181,000: Provided, That amounts appropriated under this heading may be used for grants to States under section 361 of the OAA only for disease
            prevention and health promotion programs and activities which have been demonstrated through rigorous evaluation to be evidence-based
            and effective: Provided further, That of amounts made available under this heading to carry out sections 311, 331, and 336 of the OAA, up
               to one percent of such amounts shall be available for developing and implementing evidence-based practices for enhancing senior
               nutrition: Provided further, That notwithstanding any other provision of this Act, funds made available under this heading to carry out section 311 of
            the OAA may be transferred to the Secretary of Agriculture in accordance with such section: Provided further, That none of the funds made available under this heading may be used by an eligible system (as defined in section 102 of
            the Protection and Advocacy for Individuals with Mental Illness Act (42 U.S.C. 10802)) to continue to pursue any legal action
            in a Federal or State court on behalf of an individual or group of individuals with a developmental disability (as defined
            in section 102(8)(A) of the Developmental Disabilities and Assistance and Bill of Rights Act of 2000 (20 U.S.C. 15002(8)(A))
            that is attributable to a mental impairment (or a combination of mental and physical impairments), that has as the requested
            remedy the closure of State operated intermediate care facilities for people with intellectual or developmental disabilities,
            unless reasonable public notice of the action has been provided to such individuals (or, in the case of mental incapacitation,
            the legal guardians who have been specifically awarded authority by the courts to make healthcare and residential decisions
            on behalf of such individuals) who are affected by such action, within 90 days of instituting such legal action, which informs
            such individuals (or such legal guardians) of their legal rights and how to exercise such rights consistent with current Federal
            Rules of Civil Procedure: Provided further, That the limitations in the immediately preceding proviso shall not apply in the case of an individual who is neither competent
            to consent nor has a legal guardian, nor shall the proviso apply in the case of individuals who are a ward of the State or
            subject to public guardianship.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0101
                  Aging Services Programs
                  1,468
                  1,438
                  1,463
               
               
                  0102
                  ACL Program Administration
                  39
                  39
                  38
               
               
                  0103
                  Integrated Aging and Disability Services Programs
                  43
                  43
                  41
               
               
                  0104
                  Disability Services Programs
                  284
                  283
                  239
               
               
                  0105
                  National Institute on Disability, Independent Living & Rehab Research
                  104
                  103
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  1,938
                  1,906
                  1,781
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  1,938
                  1,906
                  1,781
               
               
                  0801
                  ACL Reimbursable Programs
                  90
                  90
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,028
                  1,996
                  1,799
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  3
                  7
                  30
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  5
                  7
                  30
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,919
                  1,906
                  1,781
               
               
                  1120
                  Appropriations transferred to other accts [012â3507]
                  â3
                  
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â4
                  
                  
               
               
                  1121
                  Appropriations transferred from other acct [075â0116]
                  
                  25
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,912
                  1,931
                  1,781
               
               
                  
                  Appropriations, mandatory:
               
               
                  1221
                  PPHF Appropriations transferred from other accounts [075â0116]
                  28
                  
                  
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  7
                  65
                  18
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  60
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  67
                  65
                  18
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  1
                  23
                  
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  23
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  24
                  23
                  
               
               
                  1900
                  Budget authority (total)
                  2,031
                  2,019
                  1,799
               
               
                  1930
                  Total budgetary resources available
                  2,036
                  2,026
                  1,829
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  7
                  30
                  30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  1,261
                  1,269
                  1,224
               
               
                  3010
                  New obligations, unexpired accounts
                  2,028
                  1,996
                  1,799
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  8
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,995
                  â2,041
                  â1,984
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â32
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,269
                  1,224
                  1,039
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â163
                  â153
                  â153
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â83
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  93
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â153
                  â153
                  â153
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  1,098
                  1,116
                  1,071
               
               
                  3200
                  Obligated balance, end of year
                  1,116
                  1,071
                  886
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,979
                  1,996
                  1,799
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  1,013
                  1,214
                  1,126
               
               
                  4011
                  Outlays from discretionary balances
                  934
                  751
                  815
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,947
                  1,965
                  1,941
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â97
                  â65
                  â18
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â60
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  90
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  30
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  1,912
                  1,931
                  1,781
               
               
                  4080
                  Outlays, net (discretionary)
                  1,850
                  1,900
                  1,923
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  52
                  23
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  1
                  5
                  
               
               
                  4101
                  Outlays from mandatory balances
                  47
                  71
                  43
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  48
                  76
                  43
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â2
                  â23
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â23
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â22
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  28
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  46
                  53
                  43
               
               
                  4180
                  Budget authority, net (total)
                  1,940
                  1,931
                  1,781
               
               
                  4190
                  Outlays, net (total)
                  1,896
                  1,953
                  1,966
               
               
                  
                     
                  
               
            
         
      
      
         This account funds formula and discretionary grants that provide home and community-based services and supports to assist
            older adults and people of all ages with disabilities to live independently and to fully participate in their communities.
            ACL works with states, localities, tribal organizations, nonprofit organizations, businesses and families, and through networks
            of aging and disability organizations, to provide these services and supports which include nutrition, supportive, caregiver,
            independent living, and protection and advocacy services.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  22
                  21
                  17
               
               
                  12.1
                  Civilian personnel benefits
                  7
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  2
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  41
                  33
                  31
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1,867
                  1,843
                  1,724
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  1,939
                  1,906
                  1,781
               
               
                  99.0
                  Reimbursable obligations
                  89
                  90
                  18
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,028
                  1,996
                  1,799
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â0â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  181
                  170
                  139
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  15
                  13
                  10
               
               
                  
                     
                  
               
            
         
      
         Aging and Disability Services Programs                                                                                   
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0103
                  Integrated Aging and Disability Services Programs
                  
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0300
                  Total, direct program
                  
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  
                  25
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  25
                  25
               
               
                  1900
                  Budget authority (total)
                  
                  25
                  25
               
               
                  1930
                  Total budgetary resources available
                  
                  25
                  25
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  25
                  25
               
               
                  3020
                  Outlays (gross)
                  
                  â25
                  â25
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  25
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  25
                  25
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  â25
                  â25
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Budget extends mandatory funding for ACL's Medicare Enrollment Assistance Programs through fiscal year 2019.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  
                  24
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  
                  25
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  25
                  25
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0142â4â1â506
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  4
                  6
               
               
                  
                     
                  
               
            
         
      
         Departmental Management                                                                                                  
            
         Federal Funds
         General departmental managementFor necessary expenses, not otherwise provided, for general departmental management, including the hire of six passenger motor
            vehicles, and for carrying out titles III, XVII, XXI, and section 229 of the PHS Act, the United States-Mexico Border Health
            Commission Act, and research studies under section 1110 of the Social Security Act, $289,545,000, together with $53,445,000 from the amounts available under section 241 of the PHS Act to carry out national health or human services research and evaluation
            activities: Provided, That funds provided in this Act for embryo adoption activities may be used to provide to individuals adopting embryos, through
            grants and other mechanisms, medical and administrative services deemed necessary for such adoptions: Provided further, That such services shall be provided consistent with 42 CFR 59.5(a)(4).
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  General Departmental Management
                  461
                  458
                  290
               
               
                  0801
                  GDM Collected (Reimbursable)
                  153
                  195
                  191
               
               
                  0802
                  HCFAC (Mandatory)
                  7
                  7
                  10
               
               
                  0803
                  PHS Evaluation (Collected)
                  64
                  64
                  53
               
               
                  0804
                  MACRA (Mandatory)
                  5
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  229
                  271
                  259
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  690
                  729
                  549
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  10
                  11
                  11
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  10
                  
                  
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  461
                  458
                  290
               
               
                  1120
                  Appropriations transferred to other accts [075â1503]
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  460
                  458
                  290
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  57
                  259
                  244
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  163
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  220
                  259
                  244
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  12
                  15
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  12
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  12
                  12
                  15
               
               
                  1900
                  Budget authority (total)
                  692
                  729
                  549
               
               
                  1930
                  Total budgetary resources available
                  702
                  740
                  560
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  11
                  11
                  11
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  517
                  467
                  577
               
               
                  3010
                  New obligations, unexpired accounts
                  690
                  729
                  549
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  10
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â716
                  â619
                  â730
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â34
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  467
                  577
                  396
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â230
                  â296
                  â296
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â175
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  109
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â296
                  â296
                  â296
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  287
                  171
                  281
               
               
                  3200
                  Obligated balance, end of year
                  171
                  281
                  100
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  680
                  717
                  534
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  356
                  344
                  262
               
               
                  4011
                  Outlays from discretionary balances
                  349
                  263
                  453
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  705
                  607
                  715
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â158
                  â259
                  â244
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â158
                  â259
                  â244
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â163
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  101
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â62
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  460
                  458
                  290
               
               
                  4080
                  Outlays, net (discretionary)
                  547
                  348
                  471
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  12
                  12
                  15
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  6
                  12
                  15
               
               
                  4101
                  Outlays from mandatory balances
                  5
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  11
                  12
                  15
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources:
                  â3
                  â12
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  â12
                  
                  
               
               
                  4142
                  Offsetting collections credited to expired accounts
                  3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4150
                  Additional offsets against budget authority only (total)
                  â9
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  8
                  
                  
               
               
                  4180
                  Budget authority, net (total)
                  460
                  458
                  290
               
               
                  4190
                  Outlays, net (total)
                  555
                  348
                  471
               
               
                  
                     
                  
               
            
         
      
      
         Note.âThe reimbursable program (HCFAC) in the General Department Management (GDM) account reflects estimates of the allocation
            for 2019. Actual allocation will be determined annually.
         
         General Departmental Management (GDM) funds activities that provide leadership, policy, legal, and administrative guidance
            to HHS components, and support research to develop policy initiatives and improve existing HHS programs. GDM also funds the
            activities of the Office of the Assistant Secretary for Health, including adolescent health, disease prevention and health
            promotion, physical fitness and sports, minority health, research integrity, women's health, and programs funded through the
            Prevention and Public Health Fund.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  86
                  87
                  88
               
               
                  11.3
                  Other than full-time permanent
                  10
                  10
                  10
               
               
                  11.5
                  Other personnel compensation
                  2
                  2
                  2
               
               
                  11.7
                  Military personnel
                  3
                  3
                  3
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  101
                  102
                  103
               
               
                  12.1
                  Civilian personnel benefits
                  28
                  29
                  29
               
               
                  12.2
                  Military personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  4
                  4
                  4
               
               
                  23.1
                  Rental payments to GSA
                  17
                  16
                  16
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  2
                  2
                  2
               
               
                  24.0
                  Printing and reproduction
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  22
                  21
                  16
               
               
                  25.2
                  Other services from non-Federal sources
                  45
                  45
                  28
               
               
                  25.3
                  Other goods and services from Federal sources
                  70
                  67
                  31
               
               
                  25.4
                  Operation and maintenance of facilities
                  6
                  6
                  6
               
               
                  25.7
                  Operation and maintenance of equipment
                  5
                  5
                  5
               
               
                  26.0
                  Supplies and materials
                  2
                  2
                  2
               
               
                  31.0
                  Equipment
                  2
                  2
                  2
               
               
                  41.0
                  Grants, subsidies, and contributions
                  155
                  155
                  44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  461
                  458
                  290
               
               
                  99.0
                  Reimbursable obligations
                  229
                  271
                  259
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  690
                  729
                  549
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  899
                  965
                  978
               
               
                  1101
                  Direct military average strength employment
                  18
                  27
                  27
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  503
                  529
                  504
               
               
                  2101
                  Reimbursable military average strength employment
                  22
                  24
                  24
               
               
                  
                     
                  
               
            
         
      
         General Departmental Management                                                                                          
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0804
                  DAB (Mandatory Proposal and User Fee Collections)
                  
                  
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  
                  
                  4
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  4
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  4
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  4
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â4
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  4
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  4
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â4
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         Legislative proposals provide the Departmental Appeals Board (DAB) mandatory resources to address the Medicare appeals backlog.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  11.1
                  Reimbursable obligations: Personnel compensation: Full-time permanent
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  
                  
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  4
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  4
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9912â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  14
               
               
                  
                     
                  
               
            
         
      
         Payment to the State Response to the Opioid Abuse Crisis Account, CURES Act                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0146â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Opioid Funding
                  500
                  500
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts (object class 94.0)
                  500
                  500
                  
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  500
                  500
                  
               
               
                  1930
                  Total budgetary resources available
                  500
                  500
                  
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  500
                  500
                  
               
               
                  3020
                  Outlays (gross)
                  â500
                  â500
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  500
                  500
                  
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  500
                  500
                  
               
               
                  4180
                  Budget authority, net (total)
                  500
                  500
                  
               
               
                  4190
                  Outlays, net (total)
                  500
                  500
                  
               
               
                  
                     
                  
               
            
         
      
      
         This account, and a related special receipt account, were established to support the execution structure necessary to implement
            the 21st Century Cures Act.
         
      
         State Response to the Opioid Abuse Crisis, CURES Act 
      
      Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5627â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  3
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1140
                  General Fund Payment, State Response to the Opioid Abuse Crisis, CURES Act
                  500
                  500
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  500
                  500
                  3
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  State Response to the Opioid Abuse Crisis, Cures Act
                  â500
                  â497
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  3
                  3
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â5627â0â2â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1101
                  Appropriation (special or trust fund)
                  500
                  497
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1362]
                  â500
                  â497
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The 21st Century Cures Act authorized in 2017 and 2018 grants to states, the District of Columbia, and territories to develop
            and provide opioid abuse prevention, treatment, and recovery support services.
         
      
         Office for civil rightsFor expenses necessary for the Office for Civil Rights, $30,904,000.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office for Civil Rights (Direct)
                  39
                  39
                  31
               
               
                  0801
                  Office for Civil Rights (Reimbursable)
                  8
                  9
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  47
                  48
                  44
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  24
                  36
                  37
               
               
                  1020
                  Adjustment of unobligated bal brought forward, Oct 1
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  23
                  36
                  37
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  39
                  39
                  31
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  20
                  10
                  10
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  2
                  
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  21
                  10
                  10
               
               
                  1900
                  Budget authority (total)
                  60
                  49
                  41
               
               
                  1930
                  Total budgetary resources available
                  83
                  85
                  78
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  36
                  37
                  34
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  14
                  18
                  19
               
               
                  3010
                  New obligations, unexpired accounts
                  47
                  48
                  44
               
               
                  3020
                  Outlays (gross)
                  â43
                  â47
                  â44
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  18
                  19
                  19
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â1
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  1
                  
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  13
                  18
                  19
               
               
                  3200
                  Obligated balance, end of year
                  18
                  19
                  19
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  39
                  39
                  31
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  33
                  31
                  25
               
               
                  4011
                  Outlays from discretionary balances
                  4
                  7
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  37
                  38
                  33
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â1
                  
                  
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  39
                  39
                  31
               
               
                  4080
                  Outlays, net (discretionary)
                  36
                  38
                  33
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  21
                  10
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1
                  1
               
               
                  4101
                  Outlays from mandatory balances
                  6
                  8
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  6
                  9
                  11
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4123
                  Non-Federal sources
                  â20
                  â10
                  â10
               
               
                  4180
                  Budget authority, net (total)
                  40
                  39
                  31
               
               
                  4190
                  Outlays, net (total)
                  22
                  37
                  34
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  2
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         The Office for Civil Rights funds activities that carry out the Department's civil rights nondiscrimination, health information
            privacy, and security compliance programs.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  16
                  17
                  16
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  17
                  18
                  17
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  6
                  6
               
               
                  23.1
                  Rental payments to GSA
                  3
                  3
                  3
               
               
                  25.3
                  Other goods and services from Federal sources
                  11
                  10
                  4
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  39
                  39
                  31
               
               
                  99.0
                  Reimbursable obligations
                  8
                  9
                  13
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  47
                  48
                  44
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0135â0â1â751
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  149
                  152
                  147
               
               
                  1101
                  Direct military average strength employment
                  1
                  1
                  1
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
         Office of the national coordinator for health information technologyFor expenses necessary for the Office of the National Coordinator for Health Information Technology, including grants, contracts,
            and cooperative agreements for the development and advancement of interoperable health information technology, $38,381,000.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Health information technology (IT)
                  60
                  60
                  38
               
               
                  0002
                  Recovery Act activities
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  62
                  60
                  38
               
               
                  0801
                  Office of the National Coordinator for Health IT (ONC): Reimbursable
                  19
                  19
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  19
                  19
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  81
                  79
                  53
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  2
                  1
                  1
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  60
                  60
                  38
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  PHS and Other
                  9
                  19
                  15
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  20
                  19
                  15
               
               
                  1900
                  Budget authority (total)
                  80
                  79
                  53
               
               
                  1930
                  Total budgetary resources available
                  82
                  80
                  54
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  1
                  1
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  93
                  68
                  26
               
               
                  3010
                  New obligations, unexpired accounts
                  81
                  79
                  53
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â105
                  â121
                  â61
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  68
                  26
                  18
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â27
                  â23
                  â23
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â11
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â23
                  â23
                  â23
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  66
                  45
                  3
               
               
                  3200
                  Obligated balance, end of year
                  45
                  3
                  â5
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  80
                  79
                  53
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  51
                  67
                  45
               
               
                  4011
                  Outlays from discretionary balances
                  54
                  54
                  16
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  105
                  121
                  61
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources:
                  â24
                  â19
                  â15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â24
                  â19
                  â15
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â11
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  15
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  60
                  60
                  38
               
               
                  4080
                  Outlays, net (discretionary)
                  81
                  102
                  46
               
               
                  4180
                  Budget authority, net (total)
                  60
                  60
                  38
               
               
                  4190
                  Outlays, net (total)
                  81
                  102
                  46
               
               
                  
                     
                  
               
            
         
      
      
         This program supports coordination, leadership, and development of Federal health information technology activities and Federal
            initiatives for the nationwide advancement of private and secure interoperable health information technology, in cooperation
            with participants in the health sector. The Office of the National Coordinator for Health Information Technology was authorized
            in Title XXX of the PHS Act as added by the Health Information Technology for Economic and Clinical Health (HITECH) Act (P.L.
            111â5, Title XIII) and the 21st Century Cures Act (P.L. 114â255), for the purpose of addressing strategic planning, coordination,
            and the analysis of key technical, economic and other issues related to the public and private adoption of health information
            technology.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  18
                  17
                  17
               
               
                  11.3
                  Other than full-time permanent
                  2
                  2
                  2
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  21
                  20
                  20
               
               
                  12.1
                  Civilian personnel benefits
                  6
                  5
                  4
               
               
                  23.1
                  Rental payments to GSA
                  4
                  2
                  2
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.1
                  Advisory and assistance services
                  1
                  
                  
               
               
                  25.2
                  Other services from non-Federal sources
                  12
                  15
                  5
               
               
                  25.3
                  Other goods and services from Federal sources
                  13
                  16
                  6
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  60
                  60
                  38
               
               
                  99.0
                  Reimbursable obligations
                  21
                  19
                  15
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  81
                  79
                  53
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0130â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  185
                  162
                  162
               
               
                  1101
                  Direct military average strength employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Office of medicare hearings and appealsFor expenses necessary for the Office of Medicare Hearings and Appeals, $112,381,000, to be transferred in appropriate part from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical
            Insurance Trust Fund: Provided, That, in addition, of the amounts the Secretary retains for adjudications related to Recovery Audit Contractor
               (RAC) appeals under section 1893(h)(1)(C) of the Social Security Act, $10,000,000 shall be used as additional funds for the
               necessary expenses of the Office of Medicare Hearings and Appeals and the Departmental Appeals Board to process RAC-related
               appeals.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Medicare Hearings and Appeals (Direct)
                  107
                  107
                  112
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0799
                  Total direct obligations
                  107
                  107
                  112
               
               
                  0801
                  Office of Medicare Hearings and Appeals (RAC Mandatory)
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  107
                  107
                  122
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  86
                  107
                  112
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  21
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  107
                  107
                  112
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  10
               
               
                  1900
                  Budget authority (total)
                  107
                  107
                  122
               
               
                  1930
                  Total budgetary resources available
                  107
                  107
                  122
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  30
                  28
                  
               
               
                  3010
                  New obligations, unexpired accounts
                  107
                  107
                  122
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â106
                  â135
                  â122
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  28
                  
                  
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â43
                  â39
                  â39
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â21
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â39
                  â39
                  â39
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â13
                  â11
                  â39
               
               
                  3200
                  Obligated balance, end of year
                  â11
                  â39
                  â39
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  107
                  107
                  112
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  91
                  107
                  112
               
               
                  4011
                  Outlays from discretionary balances
                  15
                  28
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  106
                  135
                  112
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â111
                  â107
                  â112
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â21
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  25
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  4
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â5
                  28
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  10
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  10
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â10
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â5
                  28
                  
               
               
                  
                     
                  
               
            
         
      
      
         This appropriation funds the operations of the Office of Medicare Hearings and Appeals (OMHA), as authorized by the Medicare
            Prescription Drug, Improvement, and Modernization Act of 2003. OMHA provides an independent and impartial forum for the adjudication
            of claims brought by or on behalf of Medicare beneficiaries related to their benefits and care.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  55
                  61
                  63
               
               
                  11.5
                  Other personnel compensation
                  
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  55
                  62
                  64
               
               
                  12.1
                  Civilian personnel benefits
                  18
                  20
                  21
               
               
                  23.1
                  Rental payments to GSA
                  8
                  7
                  7
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  3
                  4
                  4
               
               
                  25.2
                  Other services from non-Federal sources
                  10
                  1
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  9
                  10
                  11
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  1
                  1
                  1
               
               
                  26.0
                  Supplies and materials
                  1
                  
                  1
               
               
                  31.0
                  Equipment
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  107
                  107
                  112
               
               
                  99.0
                  Reimbursable obligations
                  
                  
                  10
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  107
                  107
                  122
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  603
                  690
                  705
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  
                  
                  45
               
               
                  
                     
                  
               
            
         
      
         Office of Medicare Hearings and Appeals                                                                                  
            
         
         (Legislative proposal, subject to PAYGO)Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Reimbursable program activity
                  
                  
                  129
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  
                  
                  129
               
               
                  1930
                  Total budgetary resources available
                  
                  
                  129
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  
                  
                  129
               
               
                  3020
                  Outlays (gross)
                  
                  
                  â129
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  
                  129
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  
                  129
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  
                  â129
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         This legislative proposal provides the Office of Medicare Hearings and Appeals (OMHA) mandatory resources to address the Medicare
            appeals backlog. An additional legislative proposal would establish a post-adjudication user fee for Medicare Parts A and
            B claim appeals filed by a provider or supplier, or a State Medicaid Agency, with respect to appeals that are unfavorable
            to the appellant and for appeals that are dismissed. 
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  
                  
                  28
               
               
                  12.1
                  Civilian personnel benefits
                  
                  
                  9
               
               
                  22.0
                  Transportation of things
                  
                  
                  1
               
               
                  23.1
                  Rental payments to GSA
                  
                  
                  4
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  
                  
                  8
               
               
                  25.2
                  Other services from non-Federal sources
                  
                  
                  25
               
               
                  25.3
                  Other goods and services from Federal sources
                  
                  
                  9
               
               
                  25.4
                  Operation and maintenance of facilities
                  
                  
                  38
               
               
                  26.0
                  Supplies and materials
                  
                  
                  2
               
               
                  31.0
                  Equipment
                  
                  
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  
                  
                  129
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0139â4â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  
                  
                  200
               
               
                  
                     
                  
               
            
         
      
         Public health and social services emergency fundFor expenses necessary to support activities related to countering potential biological, nuclear, radiological, chemical,
            and cybersecurity threats to civilian populations, and for other public health emergencies, $941,523,000, of which $511,700,000 shall remain available until expended for expenses necessary to support advanced research and development pursuant to section
            319L of the PHS Act and other administrative expenses of the Biomedical Advanced Research and Development Authority: Provided, That funds provided under this heading for the purpose of acquisition of security countermeasures shall be in addition to
            any other funds available for such purpose: Provided further, That products purchased with funds provided under this heading may, at the discretion of the Secretary, be deposited in
            the Strategic National Stockpile pursuant to section 319F-2 of the PHS Act: Provided further, That $5,000,000 of the amounts made available to support emergency operations shall remain available through September 30, 2021: Provided further, That up to 10 percent of the amounts made available in this paragraph to support advanced research and development pursuant
            to section 319L of the PHS Act may also be used to supplement funds made available in the second paragraph for the purposes
            provided therein.
      For expenses necessary for procuring security countermeasures (as defined in section 319F-2(c)(1)(B) of the PHS Act) and for carrying out section 319F-2(a) of the PHS Act, $1,085,000,000, to remain available until expended: Provided, That up to 10 percent of the amounts made available in this paragraph may also be used to supplement funds made available
            in the first paragraph to support advanced research and development pursuant to section 319L of the PHS Act.
      For an additional amount for expenses necessary to prepare for or respond to an influenza pandemic, $202,378,000; of which $162,378,000 shall be available until expended, for activities including the development and purchase of vaccines, antivirals, necessary
            medical supplies, diagnostics, and other surveillance tools: Provided, That  funds may be used for the construction or renovation of privately owned facilities for the production of pandemic influenza
            vaccines and other biologics, if the Secretary finds such construction or renovation necessary to secure sufficient supplies
            of such vaccines or biologics.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Public Health and Social Services Emergency Fund
                  2,307
                  1,597
                  2,229
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0100
                  Direct program activities, subtotal
                  2,307
                  1,597
                  2,229
               
               
                  0801
                  Reimbursable program (FEMA)
                  76
                  104
                  104
               
               
                  0802
                  Reimbursable program activity (OPP)
                  2
                  2
                  2
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  78
                  106
                  106
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  2,385
                  1,703
                  2,335
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  945
                  123
                  63
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0128]
                  â1
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0343]
                  â2
                  â2
                  â3
               
               
                  1010
                  Unobligated balance transfer to other accts [075â0943]
                  â23
                  
                  
               
               
                  1010
                  Unobligated balance transfer to other accts [075â9915]
                  â66
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  64
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  917
                  121
                  60
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  1,518
                  1,563
                  2,229
               
               
                  1120
                  Appropriations transferred to other acct [075â1503]
                  â4
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  1,514
                  1,563
                  2,229
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  3
                  82
                  82
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  75
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  78
                  82
                  82
               
               
                  1900
                  Budget authority (total)
                  1,592
                  1,645
                  2,311
               
               
                  1930
                  Total budgetary resources available
                  2,509
                  1,766
                  2,371
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1940
                  Unobligated balance expiring
                  â1
                  
                  
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  123
                  63
                  36
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  4,268
                  4,745
                  1,899
               
               
                  3010
                  New obligations, unexpired accounts
                  2,385
                  1,703
                  2,335
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  12
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â1,821
                  â4,549
                  â3,073
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â64
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â35
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  4,745
                  1,899
                  1,161
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â80
                  â107
                  â107
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â75
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â107
                  â107
                  â107
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  4,188
                  4,638
                  1,792
               
               
                  3200
                  Obligated balance, end of year
                  4,638
                  1,792
                  1,054
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,592
                  1,645
                  2,311
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  283
                  1,641
                  2,306
               
               
                  4011
                  Outlays from discretionary balances
                  1,538
                  2,908
                  767
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,821
                  4,549
                  3,073
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â20
                  â82
                  â82
               
               
                  4033
                  Non-Federal sources
                  â31
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â51
                  â82
                  â82
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â75
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  48
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  â27
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  1,514
                  1,563
                  2,229
               
               
                  4080
                  Outlays, net (discretionary)
                  1,770
                  4,467
                  2,991
               
               
                  4180
                  Budget authority, net (total)
                  1,514
                  1,563
                  2,229
               
               
                  4190
                  Outlays, net (total)
                  1,770
                  4,467
                  2,991
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health and Social Services Emergency Fund (PHSSEF) provides resources to support a comprehensive program to prepare
            for the health and medical consequences of bioterrorism or other public health emergencies. This account includes funding
            for the Office of the Assistant Secretary for Preparedness and Response (ASPR), as authorized by the Pandemic and All-Hazards
            Preparedness Reauthorization Act of 2013. Funds will be used for hospital preparedness and other emergency preparedness activities
            including the National Disaster Medical System. The PHSSEF continues to support the advanced development and procurement of
            biodefense and pandemic influenza countermeasures. The FY 2019 Budget reflects the transfer of the Strategic National Stockpile
            (SNS) from the Centers for Disease Control and Prevention to ASPR.
         
         The PHSSEF also supports the HHS Cybersecurity program, National Security and Strategic Information programs, and the Medical
            Reserve Corps.
         
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  73
                  88
                  126
               
               
                  11.3
                  Other than full-time permanent
                  18
                  
                  
               
               
                  11.7
                  Military personnel
                  8
                  9
                  8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  99
                  97
                  134
               
               
                  12.1
                  Civilian personnel benefits
                  25
                  32
                  46
               
               
                  12.2
                  Military personnel benefits
                  4
                  3
                  3
               
               
                  21.0
                  Travel and transportation of persons
                  8
                  6
                  17
               
               
                  22.0
                  Transportation of things
                  1
                  
                  1
               
               
                  23.1
                  Rental payments to GSA
                  15
                  8
                  29
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  6
                  5
                  4
               
               
                  25.1
                  Advisory and assistance services
                  904
                  745
                  474
               
               
                  25.2
                  Other services from non-Federal sources
                  236
                  199
                  116
               
               
                  25.3
                  Other goods and services from Federal sources
                  69
                  54
                  222
               
               
                  25.4
                  Operation and maintenance of facilities
                  6
                  1
                  15
               
               
                  25.5
                  Research and development contracts
                  178
                  1
                  754
               
               
                  25.7
                  Operation and maintenance of equipment
                  21
                  18
                  91
               
               
                  26.0
                  Supplies and materials
                  449
                  358
                  38
               
               
                  31.0
                  Equipment
                  2
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  284
                  69
                  284
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  2,307
                  1,597
                  2,229
               
               
                  99.0
                  Reimbursable obligations
                  78
                  106
                  106
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  2,385
                  1,703
                  2,335
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0140â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  656
                  705
                  940
               
               
                  1101
                  Direct military average strength employment
                  75
                  75
                  75
               
               
                  
                     
                  
               
            
         
      
         Transfers from the Patient-Centered Outcomes Research Trust Fund                                                         
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  AHRQ
                  57
                  
                  
               
               
                  0002
                  Office of the Secretary
                  26
                  28
                  27
               
               
                  0003
                  NIRSQ
                  
                  79
                  50
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  83
                  107
                  77
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  55
                  88
                  106
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  56
                  88
                  106
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  115
                  125
                  155
               
               
                  1930
                  Total budgetary resources available
                  171
                  213
                  261
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  88
                  106
                  184
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  152
                  122
                  197
               
               
                  3010
                  New obligations, unexpired accounts
                  83
                  107
                  77
               
               
                  3020
                  Outlays (gross)
                  â112
                  â32
                  â98
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  122
                  197
                  176
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  152
                  122
                  197
               
               
                  3200
                  Obligated balance, end of year
                  122
                  197
                  176
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  115
                  125
                  155
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  2
                  4
                  5
               
               
                  4101
                  Outlays from mandatory balances
                  110
                  28
                  93
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  112
                  32
                  98
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â115
                  â125
                  â155
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â3
                  â93
                  â57
               
               
                  
                     
                  
               
            
         
      
      
         Public Law 111â148 established the Patient-Centered Outcomes Research Trust Fund (PCORTF). Beginning in FY 2011, a total of
            20 percent of the funds appropriated or credited to the PCORTF will be transferred each year to the Department of Health and
            Human Services (HHS). As authorized in section 937 of the Public Health Service Act, HHS will disseminate research findings
            from the Patient-Centered Outcomes Research Institute and other government-funded comparative clinical effectiveness research
            and coordinate Federal health programs to build research and data capacity for comparative clinical effectiveness research.
            Transferred funds were distributed to the Secretary of HHS and the Agency for Healthcare Research and Quality to carry out
            these activities. The FY 2019 Budget consolidates the Agency for Healthcare Research and Quality within the National Institutes
            of Health as the National Institute for Research on Safety and Quality. This Institute is proposed to receive the resources
            from the PCORTF that the Agency for Healthcare Research and Quality would have received under current law.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  11.1
                  Personnel compensation: Full-time permanent
                  3
                  3
                  3
               
               
                  25.1
                  Advisory and assistance services
                  7
                  30
                  26
               
               
                  25.3
                  Other goods and services from Federal sources
                  22
                  31
                  31
               
               
                  41.0
                  Grants, subsidies, and contributions
                  51
                  43
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  83
                  107
                  77
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0145â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  5
                  5
                  5
               
               
                  
                     
                  
               
            
         
      
         Nonrecurring Expenses Fund                                                                                               
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Nonrecurring Expenses Fund Projects
                  526
                  397
                  175
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  830
                  565
                  693
               
               
                  1010
                  Unobligated balance transfer to other accts [075â1503]
                  â300
                  
                  
               
               
                  1012
                  Unobligated balance transfers between expired and unexpired accounts
                  652
                  525
                  450
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  1,191
                  1,090
                  1,143
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1131
                  Unobligated balance of appropriations permanently reduced
                  â100
                  
                  
               
               
                  1930
                  Total budgetary resources available
                  1,091
                  1,090
                  1,143
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  565
                  693
                  968
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  535
                  668
                  661
               
               
                  3010
                  New obligations, unexpired accounts
                  526
                  397
                  175
               
               
                  3020
                  Outlays (gross)
                  â384
                  â404
                  â307
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  668
                  661
                  529
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  535
                  668
                  661
               
               
                  3200
                  Obligated balance, end of year
                  668
                  661
                  529
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  â100
                  
                  
               
               
                  
                  Outlays, gross:
               
               
                  4011
                  Outlays from discretionary balances
                  384
                  404
                  307
               
               
                  4180
                  Budget authority, net (total)
                  â100
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  384
                  404
                  307
               
               
                  
                     
                  
               
            
         
      
      
         The Nonrecurring Expenses Fund is a no-year account that receives transfers of expired unobligated balances from discretionary
            accounts prior to cancellation. The Fund is used for capital acquisition, including facilities infrastructure and information
            technology infrastructure.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  23.1
                  Rental payments to GSA
                  2
                  2
                  1
               
               
                  25.1
                  Advisory and assistance services
                  33
                  23
                  10
               
               
                  25.2
                  Other services from non-Federal sources
                  161
                  122
                  54
               
               
                  25.3
                  Other goods and services from Federal sources
                  26
                  20
                  9
               
               
                  25.4
                  Operation and maintenance of facilities
                  206
                  156
                  71
               
               
                  25.5
                  Research and development contracts
                  4
                  3
                  1
               
               
                  25.7
                  Operation and maintenance of equipment
                  13
                  10
                  5
               
               
                  31.0
                  Equipment
                  60
                  45
                  17
               
               
                  32.0
                  Land and structures
                  20
                  15
                  7
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  525
                  396
                  175
               
               
                  99.5
                  Adjustment for rounding
                  1
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  526
                  397
                  175
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0125â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  4
                  4
                  
               
               
                  
                     
                  
               
            
         
      
         Health Insurance Reform Implementation Fund                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0119â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  5
                  6
                  6
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  6
                  6
                  6
               
               
                  1930
                  Total budgetary resources available
                  6
                  6
                  6
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  6
                  6
                  6
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  19
                  17
                  15
               
               
                  3020
                  Outlays (gross)
                  â1
                  â2
                  â2
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  17
                  15
                  13
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  19
                  17
                  15
               
               
                  3200
                  Obligated balance, end of year
                  17
                  15
                  13
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  
                  Outlays, gross:
               
               
                  4101
                  Outlays from mandatory balances
                  1
                  2
                  2
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  1
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
      
         Section 1005 of the Health Care and Education Reconciliation Act of 2010 (P.L. 111â152) appropriated $1,000,000,000 to the
            Health Insurance Reform Implementation Fund within the Department of Health and Human Services. The Fund shall be used for
            Federal administrative expenses necessary to carry out the requirements of the Patient Protection and Affordable Care Act
            of 2010 (P.L. 111â148) and the Health Care and Education Reconciliation Act of 2010.
         
      
         Prevention and Public Health Fund                                                                                        
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0116â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1120
                  Appropriations transferred to other acct [075â0142]
                  
                  â25
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â0943]
                  
                  â805
                  
               
               
                  1120
                  Appropriations transferred to other acct [075â1362]
                  
                  â11
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  
                  â841
                  
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  1,000
                  900
                  800
               
               
                  1220
                  Appropriations transferred to other accts [075â0142]
                  â28
                  
                  
               
               
                  1220
                  Appropriations transferred to other accts [075â0943]
                  â891
                  
                  â800
               
               
                  1220
                  Appropriations transferred to other accts [075â1362]
                  â12
                  
                  
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced [SEQ]
                  â69
                  â59
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  
                  841
                  
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  
                  â841
                  
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  
                  841
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Prevention and Public Health Fund supports prevention and public health activities. In FY 2019, $800 million is available
            to support a range of public health efforts intended to prevent disease and reduce health care costs. The Secretary has authority
            to transfer to accounts within HHS.
         
      
         Pregnancy Assistance Fund                                                                                                
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Pregnancy Assistance Fund (Direct)
                  23
                  23
                  25
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  2
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  25
                  25
                  25
               
               
                  1230
                  Appropriations and/or unobligated balance of appropriations permanently reduced
                  â2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1260
                  Appropriations, mandatory (total)
                  23
                  25
                  25
               
               
                  1930
                  Total budgetary resources available
                  23
                  25
                  27
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  2
                  2
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  28
                  28
                  27
               
               
                  3010
                  New obligations, unexpired accounts
                  23
                  23
                  25
               
               
                  3020
                  Outlays (gross)
                  â23
                  â24
                  â23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  28
                  27
                  29
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  28
                  28
                  27
               
               
                  3200
                  Obligated balance, end of year
                  28
                  27
                  29
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  23
                  25
                  25
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  
                  1
                  
               
               
                  4101
                  Outlays from mandatory balances
                  23
                  23
                  23
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  23
                  24
                  23
               
               
                  4180
                  Budget authority, net (total)
                  23
                  25
                  25
               
               
                  4190
                  Outlays, net (total)
                  23
                  24
                  23
               
               
                  
                     
                  
               
            
         
      
      
         This appropriation funds competitive grants to States to assist pregnant and parenting teens and women.
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  25.3
                  Other goods and services from Federal sources
                  1
                  1
                  
               
               
                  41.0
                  Grants, subsidies, and contributions
                  22
                  22
                  25
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  23
                  23
                  25
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0117â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  2
                  2
                  2
               
               
                  
                     
                  
               
            
         
      
         Section 241 Evaluation Transactions Account                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â3902â0â1â552
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Section 241 Evaluation Transactions Account (Reimbursable)
                  476
                  473
                  418
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0809
                  Reimbursable program activities, subtotal
                  476
                  473
                  418
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 25.3)
                  476
                  473
                  418
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  58
                  473
                  418
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  418
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  476
                  473
                  418
               
               
                  1930
                  Total budgetary resources available
                  476
                  473
                  418
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  905
                  558
                  28
               
               
                  3010
                  New obligations, unexpired accounts
                  476
                  473
                  418
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  200
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â823
                  â1,003
                  â418
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â200
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  558
                  28
                  28
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â923
                  â555
                  â555
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â418
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  786
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â555
                  â555
                  â555
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â18
                  3
                  â527
               
               
                  3200
                  Obligated balance, end of year
                  3
                  â527
                  â527
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  476
                  473
                  418
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  58
                  473
                  418
               
               
                  4011
                  Outlays from discretionary balances
                  765
                  530
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  823
                  1,003
                  418
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â844
                  â473
                  â418
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â844
                  â473
                  â418
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â418
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  786
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  368
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â21
                  530
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â21
                  530
                  
               
               
                  
                     
                  
               
            
         
      
      
         The Public Health Service (PHS) Act Evaluation Transactions account supports the execution of section 241 of the PHS Act.
      
         Program Support Center                                                                                                   
            
         Federal Funds
         Retirement pay and medical benefits for commissioned officersFor retirement pay and medical benefits of Public Health Service Commissioned Officers as authorized by law, for payments
            under the Retired Serviceman's Family Protection Plan and Survivor Benefit Plan, and for medical care of dependents and retired
            personnel under chapter 55 of title 10, United States Code, such amounts as may be required during the current fiscal year.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Retirement payments
                  441
                  455
                  469
               
               
                  0002
                  Survivors' benefits
                  30
                  31
                  32
               
               
                  0003
                  Medical care
                  122
                  121
                  128
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  593
                  607
                  629
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  
                  
                  12
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1200
                  Appropriation
                  593
                  619
                  629
               
               
                  1930
                  Total budgetary resources available
                  593
                  619
                  641
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  
                  12
                  12
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  64
                  62
                  20
               
               
                  3010
                  New obligations, unexpired accounts
                  593
                  607
                  629
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  12
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â570
                  â649
                  â629
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â37
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  62
                  20
                  20
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  64
                  62
                  20
               
               
                  3200
                  Obligated balance, end of year
                  62
                  20
                  20
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  593
                  619
                  629
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  553
                  588
                  598
               
               
                  4101
                  Outlays from mandatory balances
                  17
                  61
                  31
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  570
                  649
                  629
               
               
                  4180
                  Budget authority, net (total)
                  593
                  619
                  629
               
               
                  4190
                  Outlays, net (total)
                  570
                  649
                  629
               
               
                  
                     
                  
               
            
         
      
      
         The number of beneficiaries using the Commissioned Corps system is estimated as follows:
         Retirement Pay, Survivor Benefits, and Medical Benefits
         
            
               
                  
                     
                        
                     
                  
                  
                      
                     2017
                     2018
                     2019
                  
                  
                     
                        
                     
                  
                  
                     Active Duty:
                     
                     
                     
                  
                  
                     HHS
                     4821
                     4767
                     4748
                  
                  
                     DOJ, BOP
                     832
                     853
                     853
                  
                  
                     Homeland Security
                     488
                     646
                     740
                  
                  
                     EPA
                     55
                     56
                     56
                  
                  
                     All Other
                     283
                     289
                     308
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Active Duty
                     6479
                     6611
                     6705
                  
                  
                     
                     
                     
                     
                  
                  
                     Retirees & Survivors:
                     
                     
                     
                  
                  
                     Retirees
                     6162
                     6200
                     6150
                  
                  
                     Retiree family members and survivors
                     1127
                     1135
                     1125
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     Total Retirement Pay
                     7289
                     7335
                     7275
                  
                  
                     Total Beneficiaries (active duty, retirees, survivors)
                     13768
                     14059
                     14101
                  
                  
                     
                     
                        
                     
                     
                        
                     
                     
                        
                     
                  
                  
                     
                        
                     
                  
               
            
         
         This activity funds annuities of retired Public Health Service (PHS) commissioned officers and survivors of retirees, and
            medical benefits for active duty PHS commissioned officers, retirees, and dependents of members and retirees of the PHS Commissioned
            Corps.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0379â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  13.0
                  Benefits for former personnel
                  471
                  486
                  501
               
               
                  25.6
                  Medical care
                  122
                  121
                  128
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  593
                  607
                  629
               
               
                  
                     
                  
               
            
         
      
         HHS Accrual Contribution to the Uniformed Services Retiree Health Care Fund                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0170â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Medicare eligible accruals
                  28
                  33
                  30
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations (object class 12.2)
                  28
                  33
                  30
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  28
                  33
                  30
               
               
                  1930
                  Total budgetary resources available
                  28
                  33
                  30
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3010
                  New obligations, unexpired accounts
                  28
                  33
                  30
               
               
                  3020
                  Outlays (gross)
                  â28
                  â33
                  â30
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  28
                  33
                  30
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  28
                  33
                  30
               
               
                  4180
                  Budget authority, net (total)
                  28
                  33
                  30
               
               
                  4190
                  Outlays, net (total)
                  28
                  33
                  30
               
               
                  
                     
                  
               
            
         
      
      
         The cost of medical benefits for Medicare-eligible beneficiaries is paid from the Department of Defense Medicare-Eligible
            Retiree Health Care Fund (10 U.S.C., ch. 56). Beginning in 2006, permanent indefinite authority is provided for a discretionary
            appropriation of the annual accrual payment into this fund (P.L. No. 108â375, section 725).
         
      
         Health Activities Funds                                                                                                  
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9913â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  1
                  1
                  1
               
               
                  1930
                  Total budgetary resources available
                  1
                  1
                  1
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  1
                  1
                  1
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  
                  
                  
               
               
                  
                     
                  
               
            
         
      
         HHS Service and Supply Fund                                                                                              
            
         Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0801
                  Program Support Center
                  1,176
                  1,395
                  1,333
               
               
                  0802
                  OS activities
                  441
                  454
                  470
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  1,617
                  1,849
                  1,803
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  181
                  201
                  295
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  76
                  181
                  181
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  257
                  382
                  476
               
               
                  
                  Budget authority:
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  1,485
                  1,762
                  1,508
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  76
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  1,561
                  1,762
                  1,508
               
               
                  1930
                  Total budgetary resources available
                  1,818
                  2,144
                  1,984
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  201
                  295
                  181
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  909
                  1,011
                  300
               
               
                  3010
                  New obligations, unexpired accounts
                  1,617
                  1,849
                  1,803
               
               
                  3020
                  Outlays (gross)
                  â1,439
                  â2,379
                  â1,508
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â76
                  â181
                  â181
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  1,011
                  300
                  414
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â460
                  â536
                  â536
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  â76
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â536
                  â536
                  â536
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  449
                  475
                  â236
               
               
                  3200
                  Obligated balance, end of year
                  475
                  â236
                  â122
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  1,561
                  1,762
                  1,508
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  857
                  1,762
                  1,508
               
               
                  4011
                  Outlays from discretionary balances
                  582
                  617
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  1,439
                  2,379
                  1,508
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â1,178
                  â1,762
                  â1,508
               
               
                  4033
                  Non-Federal sources
                  â307
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4040
                  Offsets against gross budget authority  and outlays (total)
                  â1,485
                  â1,762
                  â1,508
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â76
                  
                  
               
               
                  4080
                  Outlays, net (discretionary)
                  â46
                  617
                  
               
               
                  4180
                  Budget authority, net (total)
                  
                  
                  
               
               
                  4190
                  Outlays, net (total)
                  â46
                  617
                  
               
               
                  
                     
                  
               
            
         
      
      
         The HHS Service and Supply Fund (SSF) provides a wide range of logistical and support services to components of the Department
            and other Federal agencies. The Program Support Center includes activities such as personnel and payroll support, information
            technology, financial management operations, and administrative services, including acquisitions management, building and
            property management, telecommunication services, medical supplies repackaging and distribution services, and the Federal Occupational
            Health Service. The Office of the Secretary activities include the Service and Supply Fund Manager's Office, departmental
            contracts, audit resolutions, Commissioned Corps force management, web management, claims, acquisition integration and modernization,
            small business consolidation, grants tracking, the physical security component of the Department's implementation of Homeland
            Security Presidential Directive 12, and commercial services management.
         
         Most Commissioned Corps officers work for agencies in the Department of Health and Human Services and are reflected in the
            agencies' personnel summaries. However, some officers are assigned to other Federal agencies. The allocation account section
            in the following personnel summary shows officers assigned to other agencies, which are paid directly by that agency, either
            through an allocation account or by directly citing that agency's appropriation.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Reimbursable obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  93
                  104
                  105
               
               
                  11.3
                  Other than full-time permanent
                  4
                  5
                  4
               
               
                  11.5
                  Other personnel compensation
                  3
                  3
                  3
               
               
                  11.7
                  Military personnel
                  6
                  7
                  7
               
               
                  11.8
                  Special personal services payments
                  9
                  8
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  115
                  127
                  128
               
               
                  12.1
                  Civilian personnel benefits
                  31
                  33
                  34
               
               
                  12.2
                  Military personnel benefits
                  3
                  2
                  2
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  4
                  2
               
               
                  22.0
                  Transportation of things
                  2
                  5
                  5
               
               
                  23.1
                  Rental payments to GSA
                  19
                  20
                  21
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  8
                  12
                  12
               
               
                  24.0
                  Printing and reproduction
                  5
                  6
                  6
               
               
                  25.1
                  Advisory and assistance services
                  122
                  165
                  172
               
               
                  25.2
                  Other services from non-Federal sources
                  1,102
                  1,165
                  1,147
               
               
                  25.3
                  Other goods and services from Federal sources
                  87
                  109
                  90
               
               
                  25.4
                  Operation and maintenance of facilities
                  10
                  20
                  14
               
               
                  25.6
                  Medical care
                  23
                  35
                  36
               
               
                  25.7
                  Operation and maintenance of equipment
                  45
                  66
                  66
               
               
                  26.0
                  Supplies and materials
                  39
                  75
                  63
               
               
                  31.0
                  Equipment
                  4
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  1,617
                  1,849
                  1,803
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9941â0â4â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  930
                  930
                  930
               
               
                  2101
                  Reimbursable military average strength employment
                  71
                  71
                  71
               
               
                  3101
                  Allocation account military average strength employment
                  1,603
                  1,788
                  1,901
               
               
                  
                     
                  
               
            
         
      
      Trust Funds  
         Miscellaneous Trust Funds                                                                                                
            
         Special and Trust Fund Receipts (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  0100
                  Balance, start of year
                  
                  
                  5
               
               
                  
                  Receipts:
               
               
                  
                  Current law:
               
               
                  1130
                  Contributions, Indian Health Facilities
                  14
                  48
                  48
               
               
                  1130
                  Contributions, N.I.H., Unconditional Gift Fund
                  6
                  3
                  3
               
               
                  1130
                  Centers for Disease Control, Gifts and Donations
                  20
                  15
                  15
               
               
                  1130
                  Contributions, N.I.H., Conditional Gift Fund
                  47
                  27
                  27
               
               
                  1130
                  Contributions to the Indian Health Service Gift Fund
                  
                  1
                  1
               
               
                  1140
                  Interest, Miscellaneous Trust Funds
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1199
                  Total current law receipts
                  88
                  95
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1999
                  Total receipts
                  88
                  95
                  95
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  2000
                  Total: Balances and receipts
                  88
                  95
                  100
               
               
                  
                  Appropriations:
               
               
                  
                  Current law:
               
               
                  2101
                  Miscellaneous Trust Funds
                  â88
                  â90
                  â84
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  5099
                  Balance, end of year
                  
                  5
                  16
               
               
                  
                     
                  
               
            
         
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0002
                  Gifts
                  79
                  110
                  110
               
               
                  0003
                  Contributions, Indian Health Facilities
                  13
                  9
                  9
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  92
                  119
                  119
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  198
                  199
                  239
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  5
                  8
                  8
               
               
                  1033
                  Recoveries of prior year paid obligations
                  
                  61
                  61
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  203
                  268
                  308
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, mandatory:
               
               
                  1201
                  Appropriation (special or trust fund)
                  88
                  90
                  84
               
               
                  1930
                  Total budgetary resources available
                  291
                  358
                  392
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  199
                  239
                  273
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  61
                  72
                  41
               
               
                  3010
                  New obligations, unexpired accounts
                  92
                  119
                  119
               
               
                  3020
                  Outlays (gross)
                  â76
                  â142
                  â142
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â5
                  â8
                  â8
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  72
                  41
                  10
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  61
                  72
                  41
               
               
                  3200
                  Obligated balance, end of year
                  72
                  41
                  10
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  88
                  90
                  84
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  20
                  9
                  8
               
               
                  4101
                  Outlays from mandatory balances
                  56
                  133
                  134
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  76
                  142
                  142
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  
                  â61
                  â61
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4143
                  Recoveries of prior year paid obligations, unexpired accounts
                  
                  61
                  61
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4160
                  Budget authority, net (mandatory)
                  88
                  90
                  84
               
               
                  4170
                  Outlays, net (mandatory)
                  76
                  81
                  81
               
               
                  4180
                  Budget authority, net (total)
                  88
                  90
                  84
               
               
                  4190
                  Outlays, net (total)
                  76
                  81
                  81
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5000
                  Total investments, SOY: Federal securities: Par value
                  21
                  34
                  34
               
               
                  5001
                  Total investments, EOY: Federal securities: Par value
                  34
                  34
                  34
               
               
                  
                     
                  
               
            
         
      
      
         Gifts to the Public Health Service are for the benefit of patients and for research. Contributions are made for the construction,
            improvement, extension, and provision of sanitation facilities.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  3
                  3
                  3
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  4
                  4
                  4
               
               
                  12.1
                  Civilian personnel benefits
                  1
                  1
                  1
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  2
                  2
               
               
                  25.1
                  Advisory and assistance services
                  4
                  6
                  6
               
               
                  25.2
                  Other services from non-Federal sources
                  17
                  25
                  25
               
               
                  25.3
                  Other goods and services from Federal sources
                  7
                  7
                  7
               
               
                  25.5
                  Research and development contracts
                  5
                  5
                  5
               
               
                  25.6
                  Medical care
                  3
                  3
                  3
               
               
                  26.0
                  Supplies and materials
                  7
                  7
                  7
               
               
                  31.0
                  Equipment
                  1
                  1
                  1
               
               
                  41.0
                  Grants, subsidies, and contributions
                  41
                  58
                  58
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  92
                  119
                  119
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â9971â0â7â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  35
                  35
                  35
               
               
                  
                     
                  
               
            
         
      
         Office of the Inspector General                                                                                          
            
         Federal Funds
         Office of inspector generalFor expenses necessary for the Office of Inspector General, including the hire of passenger motor vehicles for investigations,
            in carrying out the provisions of the Inspector General Act of 1978, $80,000,000: Provided, That of such amount, necessary sums shall be available for providing protective services to the Secretary and investigating
            non-payment of child support cases for which non-payment is a Federal offense under 18 U.S.C. 228.
      Note.â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. 115â56, as amended).
         The amounts included for 2018 reflect the annualized level provided by the continuing resolution.
      
      Program and Financing (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Obligations by program activity:
               
               
                  0001
                  Office of Inspector General (Direct)
                  81
                  81
                  80
               
               
                  0801
                  Office of Inspector General HCFAC Trust Fund
                  206
                  217
                  232
               
               
                  0802
                  Office of Inspector General (Direct Reimbursable)
                  16
                  21
                  21
               
               
                  0803
                  Office of Inspector General HCFAC Discretionary
                  86
                  88
                  87
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0899
                  Total reimbursable obligations
                  308
                  326
                  340
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  0900
                  Total new obligations, unexpired accounts
                  389
                  407
                  420
               
               
                  
                     
                  
               
               
                  
                  Budgetary resources:
               
               
                  
                  Unobligated balance:
               
               
                  1000
                  Unobligated balance brought forward, Oct 1
                  34
                  41
                  20
               
               
                  1001
                  Discretionary unobligated balance brought fwd, Oct 1
                  1
                  7
                  
               
               
                  1011
                  Unobligated balance transfer from other acct [075â0140]
                  1
                  
                  
               
               
                  1021
                  Recoveries of prior year unpaid obligations
                  13
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1050
                  Unobligated balance (total)
                  48
                  41
                  20
               
               
                  
                  Budget authority:
               
               
                  
                  Appropriations, discretionary:
               
               
                  1100
                  Appropriation
                  80
                  80
                  80
               
               
                  1121
                  Appropriations transferred from other acct [075â9911]
                  2
                  1
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1160
                  Appropriation, discretionary (total)
                  82
                  81
                  80
               
               
                  
                  Spending authority from offsetting collections, discretionary:
               
               
                  1700
                  Collected
                  96
                  103
                  109
               
               
                  1701
                  Change in uncollected payments, Federal sources
                  2
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1750
                  Spending auth from offsetting collections, disc (total)
                  98
                  103
                  109
               
               
                  
                  Spending authority from offsetting collections, mandatory:
               
               
                  1800
                  Collected
                  209
                  202
                  220
               
               
                  1801
                  Change in uncollected payments, Federal sources
                  â7
                  
                  
               
               
                  1802
                  Offsetting collections (previously unavailable)
                  1
                  
                  
               
               
                  1823
                  New and/or unobligated balance of spending authority from offsetting collections temporarily reduced
                  â1
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  1850
                  Spending auth from offsetting collections, mand (total)
                  202
                  202
                  220
               
               
                  1900
                  Budget authority (total)
                  382
                  386
                  409
               
               
                  1930
                  Total budgetary resources available
                  430
                  427
                  429
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  1941
                  Unexpired unobligated balance, end of year
                  41
                  20
                  9
               
               
                  
                     
                  
               
               
                  
                  Change in obligated balance:
               
               
                  
                  Unpaid obligations:
               
               
                  3000
                  Unpaid obligations, brought forward, Oct 1
                  67
                  78
                  104
               
               
                  3010
                  New obligations, unexpired accounts
                  389
                  407
                  420
               
               
                  3011
                  Obligations ("upward adjustments"), expired accounts
                  1
                  
                  
               
               
                  3020
                  Outlays (gross)
                  â363
                  â381
                  â413
               
               
                  3040
                  Recoveries of prior year unpaid obligations, unexpired
                  â13
                  
                  
               
               
                  3041
                  Recoveries of prior year unpaid obligations, expired
                  â3
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3050
                  Unpaid obligations, end of year
                  78
                  104
                  111
               
               
                  
                  Uncollected payments:
               
               
                  3060
                  Uncollected pymts, Fed sources, brought forward, Oct 1
                  â130
                  â114
                  â114
               
               
                  3070
                  Change in uncollected pymts, Fed sources, unexpired
                  5
                  
                  
               
               
                  3071
                  Change in uncollected pymts, Fed sources, expired
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  3090
                  Uncollected pymts, Fed sources, end of year
                  â114
                  â114
                  â114
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  3100
                  Obligated balance, start of year
                  â63
                  â36
                  â10
               
               
                  3200
                  Obligated balance, end of year
                  â36
                  â10
                  â3
               
               
                  
                     
                  
               
               
                  
                  Budget authority and outlays, net:
               
               
                  
                  Discretionary:
               
               
                  4000
                  Budget authority, gross
                  180
                  184
                  189
               
               
                  
                  Outlays, gross:
               
               
                  4010
                  Outlays from new discretionary authority
                  151
                  168
                  172
               
               
                  4011
                  Outlays from discretionary balances
                  22
                  19
                  17
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4020
                  Outlays, gross (total)
                  173
                  187
                  189
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4030
                  Federal sources
                  â107
                  â103
                  â109
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4050
                  Change in uncollected pymts, Fed sources, unexpired
                  â2
                  
                  
               
               
                  4052
                  Offsetting collections credited to expired accounts
                  11
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4060
                  Additional offsets against budget authority only (total)
                  9
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4070
                  Budget authority, net (discretionary)
                  82
                  81
                  80
               
               
                  4080
                  Outlays, net (discretionary)
                  66
                  84
                  80
               
               
                  
                  Mandatory:
               
               
                  4090
                  Budget authority, gross
                  202
                  202
                  220
               
               
                  
                  Outlays, gross:
               
               
                  4100
                  Outlays from new mandatory authority
                  136
                  184
                  200
               
               
                  4101
                  Outlays from mandatory balances
                  54
                  10
                  24
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4110
                  Outlays, gross (total)
                  190
                  194
                  224
               
               
                  
                  Offsets against gross budget authority and outlays:
               
               
                  
                  Offsetting collections (collected) from:
               
               
                  4120
                  Federal sources
                  â199
                  â191
                  â208
               
               
                  4123
                  Non-Federal sources
                  â10
                  â11
                  â12
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  4130
                  Offsets against gross budget authority and outlays (total)
                  â209
                  â202
                  â220
               
               
                  
                  Additional offsets against gross budget authority only:
               
               
                  4140
                  Change in uncollected pymts, Fed sources, unexpired
                  7
                  
                  
               
               
                  4170
                  Outlays, net (mandatory)
                  â19
                  â8
                  4
               
               
                  4180
                  Budget authority, net (total)
                  82
                  81
                  80
               
               
                  4190
                  Outlays, net (total)
                  47
                  76
                  84
               
               
                  
                     
                  
               
               
                  
                  Memorandum (non-add) entries:
               
               
                  5090
                  Unexpired unavailable balance, SOY: Offsetting collections
                  1
                  1
                  1
               
               
                  5092
                  Unexpired unavailable balance, EOY: Offsetting collections
                  1
                  1
                  1
               
               
                  
                     
                  
               
            
         
      
      
         The mission of the Office of Inspector General (OIG) is to protect the integrity of the U.S. Department of Health and Human
            Services (HHS) programs and the health and welfare of the people they serve. As established by the Inspector General Act of
            1978, OIG is an independent and objective organization that fights fraud, waste, and abuse and promotes efficiency, economy,
            and effectiveness in HHS programs and operations. OIG works to ensure that Federal dollars are used appropriately and that
            HHS programs well serve the people that use them. OIG fulfills its mission through a broad range of audits, evaluations, investigations,
            and enforcement and compliance activities. In addition to discretionary appropriations, OIG receives funds through the Health
            Care Fraud and Abuse Control (HCFAC) account created by the Health Insurance Portability and Accountability Act of 1996.
         
      
      Object Classification (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  
                  Direct obligations:
               
               
                  
                  Personnel compensation:
               
               
                  11.1
                  Full-time permanent
                  40
                  40
                  40
               
               
                  11.3
                  Other than full-time permanent
                  1
                  1
                  1
               
               
                  11.5
                  Other personnel compensation
                  1
                  1
                  1
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  11.9
                  Total personnel compensation
                  42
                  42
                  42
               
               
                  12.1
                  Civilian personnel benefits
                  16
                  16
                  16
               
               
                  21.0
                  Travel and transportation of persons
                  2
                  1
                  2
               
               
                  22.0
                  Transportation of things
                  1
                  1
                  1
               
               
                  23.1
                  Rental payments to GSA
                  4
                  5
                  5
               
               
                  23.3
                  Communications, utilities, and miscellaneous charges
                  1
                  1
                  1
               
               
                  25.2
                  Other services from non-Federal sources
                  1
                  1
                  2
               
               
                  25.3
                  Other goods and services from Federal sources
                  8
                  8
                  7
               
               
                  25.4
                  Operation and maintenance of facilities
                  1
                  1
                  1
               
               
                  31.0
                  Equipment
                  5
                  5
                  5
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.0
                  Direct obligations
                  81
                  81
                  82
               
               
                  99.0
                  Reimbursable obligations
                  308
                  326
                  338
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  99.9
                  Total new obligations, unexpired accounts
                  389
                  407
                  420
               
               
                  
                     
                  
               
            
         
      
      Employment Summary
      
         
            
               
                  
                     
                  
               
               
                  Identification code 075â0128â0â1â551
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  1001
                  Direct civilian full-time equivalent employment
                  355
                  347
                  347
               
               
                  2001
                  Reimbursable civilian full-time equivalent employment
                  1,253
                  1,285
                  1,303
               
               
                  
                     
                  
               
            
         
      
         General and Administrative Provisions                                                                                    
            
         
         GENERAL FUND RECEIPT ACCOUNTS                                                                                            
            
         (in millions of dollars)
      
         
            
               
                  
                     
                  
               
               
                  
                  2017 actual
                  2018 est.
                  2019 est.
               
               
                  
                     
                  
               
               
                  Offsetting receipts from the public:
               
               
                  075â143500
                  General Fund Proprietary Interest Receipts, not Otherwise Classified
                  106
                  90
                  90
               
               
                  075â267403
                  Consumer Operated and Oriented Plan Direct Loan Program, Downward Reestimate of Subsidies
                  127
                  15
                  
               
               
                  075â275830
                  Downward Reestimates of Subsidies, Health Centers
                  1
                  
                  
               
               
                  075â310700
                  Federal Share of Child Support Collections
                  633
                  621
                  608
               
               
                  075â310700
                  Federal Share of Child Support Collections: Legislative proposal, subject to PAYGO
                  
                  
                  11
               
               
                  075â322000
                  All Other General Fund Proprietary Receipts Including Budget Clearing Accounts
                  57
                  34
                  34
               
               
                  General Fund Offsetting receipts from the public
                  924
                  760
                  743
               
               
                  
                     
                  
               
               
                  
               
               
                  Intragovernmental payments:
               
               
                  075â388500
                  Undistributed Intragovernmental Payments and Receivables from Cancelled Accounts
                  87
                  
                  
               
               
                  
                  
                  
                     
                  
                  
                     
                  
                  
                     
                  
               
               
                  General Fund Intragovernmental payments
                  87
                  
                  
               
               
                  
                     
                  
               
            
         
      
      
          
      
         GENERAL PROVISIONS                                                                                                       
            
         SEC. 201. Funds appropriated in this title shall be available for not to exceed $50,000 for official reception and representation expenses
      when specifically approved by the Secretary.SEC. 202. None of the funds appropriated in this title shall be used to pay the salary of an individual, through a discretionary grant
      or other extramural mechanism, at a rate in excess of Executive Level V, except that this section shall not apply to the Head
      Start program.SEC. 203. Notwithstanding section 241(a) of the PHS Act, such portion as the Secretary shall determine, but not more than 2.9 percent,
      of any amounts appropriated for programs authorized under such Act shall be made available for the evaluation (directly, or
      by grants or contracts) and the implementation and effectiveness of programs funded in this title.'
      			
      (transfer of funds)SEC. 204. Not to exceed 1 percent of any discretionary funds (pursuant to the Balanced Budget and Emergency Deficit Control Act of 1985)
      which are appropriated for the current fiscal year for HHS in this Act may be transferred between appropriations, but no such
      appropriation shall be increased by more than 3 percent by any such transfer: Provided, That the transfer authority granted by this section shall not be used to create any new program or to fund any project or
      activity for which no funds are provided in this Act: Provided further, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.SEC. 205. In lieu of the timeframe specified in section 338E(c)(2) of the PHS Act, terminations described in such section may occur
      up to 60 days after the execution of a contract awarded in fiscal year 2019 under section 338B of such Act.SEC. 206. None of the funds appropriated in this Act may be made available to any entity under title X of the PHS Act unless the applicant
      for the award certifies to the Secretary that it encourages family participation in the decision of minors to seek family
      planning services and that it provides counseling to minors on how to resist attempts to coerce minors into engaging in sexual
      activities.SEC. 207. Notwithstanding any other provision of law, no provider of services under title X of the PHS Act shall be exempt from any
      State law requiring notification or the reporting of child abuse, child molestation, sexual abuse, rape, or incest.SEC. 208. None of the funds appropriated by this Act (including funds appropriated to any trust fund) may be used to carry out the Medicare
      Advantage program if the Secretary denies participation in such program to an otherwise eligible entity (including a Provider
      Sponsored Organization) because the entity informs the Secretary that it will not provide, pay for, provide coverage of, or
      provide referrals for abortions: Provided, That the Secretary shall make appropriate prospective adjustments to the capitation payment to such an entity (based on
      an actuarially sound estimate of the expected costs of providing the service to such entity's enrollees): Provided further, That nothing in this section shall be construed to change the Medicare program's coverage for such services and a Medicare
      Advantage organization described in this section shall be responsible for informing enrollees where to obtain information
      about all Medicare covered services.SEC. 209. None of the funds made available in this title may be used, in whole or in part, to advocate or promote gun control.SEC. 210. In order for HHS to carry out international health activities, including HIV/AIDS and other infectious disease, chronic and
      environmental disease, and other health activities abroad during fiscal year 2019:
      (1) The Secretary may exercise authority equivalent to that available to the Secretary of State in section 2(c) of the State Department
         Basic Authorities Act of 1956. The Secretary shall consult with the Secretary of State and relevant Chief of Mission to ensure
         that the authority provided in this section is exercised in a manner consistent with section 207 of the Foreign Service Act
         of 1980 and other applicable statutes administered by the Department of State.
      
      (2) The Secretary is authorized to provide such funds by advance or reimbursement to the Secretary of State as may be necessary
         to pay the costs of acquisition, lease, alteration, renovation, and management of facilities outside of the United States
         for the use of HHS. The Department of State shall cooperate fully with the Secretary to ensure that HHS has secure, safe,
         functional facilities that comply with applicable regulation governing location, setback, and other facilities requirements
         and serve the purposes established by this Act. The Secretary is authorized, in consultation with the Secretary of State,
         through grant or cooperative agreement, to make available to public or nonprofit private institutions or agencies in participating
         foreign countries, funds to acquire, lease, alter, or renovate facilities in those countries as necessary to conduct programs
         of assistance for international health activities, including activities relating to HIV/AIDS and other infectious diseases,
         chronic and environmental diseases, and other health activities abroad.
      
      (3) The Secretary is authorized to provide to personnel appointed or assigned by the Secretary to serve abroad, allowances and
         benefits similar to those provided under chapter 9 of title I of the Foreign Service Act of 1980, and 22 U.S.C. 4081 through
         4086 and subject to such regulations prescribed by the Secretary. The Secretary is further authorized to provide locality-based
         comparability payments (stated as a percentage) up to the amount of the locality-based comparability payment (stated as a
         percentage) that would be payable to such personnel under section 5304 of title 5, United States Code if such personnel's
         official duty station were in the District of Columbia. Leaves of absence for personnel under this subsection shall be on
         the same basis as that provided under subchapter I of chapter 63 of title 5, United States Code, or section 903 of the Foreign
         Service Act of 1980, to individuals serving in the Foreign Service.
      '
      			
      (transfer of funds)SEC. 211. The Director of the NIH, jointly with the Director of the Office of AIDS Research, may transfer up to 3 percent among institutes
      and centers from the total amounts identified by these two Directors as funding for research pertaining to the human immunodeficiency
      virus: Provided, That the Committees on Appropriations of the House of Representatives and the Senate are notified at least 15 days in advance
      of any transfer.'
      			
      (transfer of funds)SEC. 212. Of the amounts made available in this Act for NIH, the amount for research related to the human immunodeficiency virus, as
      jointly determined by the Director of NIH and the Director of the Office of AIDS Research, shall be made available to the
      "Office of AIDS Research" account. The Director of the Office of AIDS Research shall transfer from such account amounts necessary
      to carry out section 2353(d)(3) of the PHS Act.SEC. 213. (a) Authority.âNotwithstanding any other provision of law, the Director of NIH ("Director") may use funds available under section 402(b)(7)
      or 402(b)(12) of the PHS Act to enter into transactions (other than contracts, cooperative agreements, or grants) to carry
      out research identified pursuant to such section 402(b)(7) (pertaining to the Common Fund) or research and activities described
      in such section 402(b)(12).
      (b) Peer review.âIn entering into transactions under subsection (a), the Director may utilize such peer review procedures (including consultation
         with appropriate scientific experts) as the Director determines to be appropriate to obtain assessments of scientific and
         technical merit. Such procedures shall apply to such transactions in lieu of the peer review and advisory council review procedures
         that would otherwise be required under sections 301(a)(3), 405(b)(1)(B), 405(b)(2), 406(a)(3)(A), 492, and 494 of the PHS
         Act.
      SEC. 214. Not to exceed $45,000,000 of funds appropriated by this Act to the institutes and centers of the National Institutes of Health
      may be used for alteration, repair, or improvement of facilities, as necessary for the proper and efficient conduct of the
      activities authorized herein, at not to exceed $3,500,000 per project.'
      			
      (transfer of funds)SEC. 215. (a) The Biomedical Advanced Research and Development Authority ("BARDA") may enter into a contract, for more than one but no more
      than 10 program years, for purchase of research services or of security countermeasures, as that term is defined in section
      319F-2(c)(1)(B) of the PHS Act (42 U.S.C. 247d-6b(c)(1)(B)), ifâ
      (1) funds are available and obligatedâ
         (A) for the full period of the contract or for the first fiscal year in which the contract is in effect; and
         (B) for the estimated costs associated with a necessary termination of the contract; and
      
      (2) the Secretary determines that a multi-year contract will serve the best interests of the Federal Government by encouraging
         full and open competition or promoting economy in administration, performance, and operation of BARDA's programs.
      
      (b) A contract entered into under this sectionâ
         (1) shall include a termination clause as described by subsection (c) of section 3903 of title 41, United States Code; and
         (2) shall be subject to the congressional notice requirement stated in subsection (d) of such section.
      SEC. 216. Section 229 of division H of Public Law 114â113 shall continue in effect through January 1, 2020.SEC. 217. (a) In general.âUnder the conditions listed in subsection (b), the Secretary or the head of a major organizational unit within the Department
      may in this fiscal year enter into a reimbursable agreement with the head of another major organizational unit within the
      Department or of another agency under whichâ
      (1) the head of the ordering agency or unit delegates to the head of the servicing agency or unit the authority to issue a grant
         or cooperative agreement on behalf of the ordering agency or unit;
      
      (2) the servicing agency or unit will execute or manage a grant or cooperative agreement on behalf of the ordering agency or unit;
         and
      
      (3) the ordering agency or unit will reimburse the servicing unit or agency for the amount of the grant or cooperative agreement
         and for the service of executing or managing the grant or cooperative agreement.
      
      (b) Conditions.âThe conditions for making an agreement described in subsection (a) are that â
         (1) amounts are available;
         (2) the head of the ordering agency or unit decides the agreement is in the best interest of the United States Government; and
         (3) the agency or unit to execute or manage the grant or cooperative agreement is able to provide that service.
      
      (c) Payment.âPayment shall be made promptly through the Intra-governmental Payment and Collection system at the request of the agency
         or unit providing the service. Payment may be in advance or on providing all or part of the service, and shall be for any
         part of the estimated or actual cost as determined by the agency or unit providing the service. A bill submitted or a request
         for payment is not subject to audit or certification in advance of payment. Proper adjustment of amounts paid in advance shall
         be made as agreed to by the heads of the agencies or units on the basis of the amount of the grant or cooperative agreement
         and the actual cost of the service provided.
      
      (d) Limitations on funds.âA condition or limitation applicable to amounts for grant or cooperative agreements of the ordering agency or unit applies
         to an agreement made under this section and to a grant or cooperative agreement made under such agreement.
      
      (e) Obligation of appropriations.âAn agreement made under this section obligates an appropriation of the ordering agency or unit. The amount obligated is
         deobligated to the extent that the agency or unit providing the service has not incurred obligations, before the end of the
         period of availability of the appropriation, in â
         (1) awarding the grant or cooperative agreement; or
         (2) providing the agreed-on services.
      
      (f) No effect on other laws.âThis section does not affect other laws about reimbursable agreements.SEC. 218. There is hereby established in the Treasury of the United States a fund to be known as the "Federal Emergency Response Fund"
      (the Fund). Amounts in the Fund shall be available, in addition to any other amount appropriated for such purposes, to carry
      out titles II, III, and XVII of the PHS Act with respect to domestic preparedness and global health; to prevent, prepare for, or respond to a chemical, biological, radiological, or nuclear threat; to prevent, prepare for,
      or respond to an emerging infectious disease; and to purchase or lease, and provide for the insurance of, passenger motor
      vehicles for official use in foreign countries. Amounts in the Fund may only be used for a public health threat or emergency
      that the Secretary determines has significant potential to occur and potential, on occurrence, to affect national security
      or the health and security of United States citizens, domestically or internationally. The Secretary may transfer to the Fund
      in this fiscal year and hereafter such amounts as are necessary from any discretionary amounts (pursuant to the Balanced Budget
      and Emergency Deficit Control Act of 1985) appropriated in this and subsequent Acts, provided that no such appropriation is
      reduced by more than 1 percent. Such transferred amounts shall remain available until expended. When implementing response
      activities, amounts in the Fund may be transferred to other accounts of the Department of Health and Human Services for the
      purposes provided in this section. The Committees on Appropriations of the House of Representatives and the Senate shall be
      notified promptly of the initiation of response activities under this authority and of any transfer made under the authority
      provided in this section. The Committees on Appropriations of the House of Representatives and the Senate shall receive a
      report not later than 45 days after the end of each quarter in a fiscal year on the unobligated balances in the Response Fund
      and all actual obligations incurred for that fiscal year, including obligations by program, project, or activity. The transfer
      authorities in this section are in addition to any other transfer authority otherwise available to the Department of Health
      and Human Services. Products purchased using amounts in the Fund may, at the discretion of the Secretary of Health and Human
      Services, be deposited in the Strategic National Stockpile under section 319F-2 of the PHS Act.SEC. 219. Funds appropriated in this Act to accounts that received appropriations in the Department of Health and Human Services Appropriations
      Act, 2017, for the administrative expenses of programs or activities that do not receive appropriations from this Act shall be available
      for necessary expenses to carry out closure of such programs or activities.SEC. 220. Notwithstanding section 1864(e) of the Social Security Act (42 U.S.C. 1395aa(e)), the Secretary shall charge health care facilities or entities fees in cases where such facilities or entities have been cited for deficiencies during initial certification, recertification,
      or substantiated complaint surveys to cover all or a portion of the costs incurred for conducting substantiated complaint
      surveys and revisit surveys on such health care facilities and entities. Such fees shall be in addition to any other funds available for conducting such surveys and shall be credited to the "Department of Health and Human ServicesâCenters for Medicare and Medicaid ServicesâProgram Management" account, to remain available until expended for such purpose. No such fees shall be charged to an Indian Health Program (as that term is defined in section 4 of the Indian Health Care
         Improvement Act).SEC. 221.   Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amendedâ (a)  in subsection (a)(5)(C)â (1)  by striking "A covered entity shall permit" and inserting "(i) DUPLICATE DISCOUNTS AND DRUG RESALE.âA covered entity shall
                  permit" 
         (2)  by inserting at the end the following: 
         
            "(ii) USE OF SAVINGS.âA covered entity shall permit the Secretary to audit at the Secretary's expense the records of the entity
                     to determine how net income from purchases under this section are used by the covered entity.
         
         
            "(iii) RECORDS RETENTION.â Covered entities shall retain such records and provide such records and reports as deemed necessary
                     by the Secretary for carrying out this subparagraph.".
         
      
      (b)  by adding at the end the following new subsection: "(f) REGULATIONS.âThe Secretary may promulgate such regulations as the
               Secretary determines necessary or appropriate to carry out the provisions of this section.". SEC. 222. (a)  IN GENERAL.âA State or tribal organization which receives grant funds attributable to appropriations under the heading "Department
            of Health and Human ServicesâAdministration for Community LivingâAging and Disability Services Programs" to carry out programs
            under parts B, C, D, or E of title III (with respect to States) or under title VI (with respect to tribal organizations) of
            the Older Americans Act of 1965 (OAA) may elect to transfer up to 100 percent of such received funds among such title III
            or title VI programs (respectively), subject to OAA sections 306(a)(9) and 307(a)(9) but notwithstanding any otherwise-applicable
            limitations on such transfers under the OAA or such heading. (b)  NOTIFICATION OF PROPOSED TRANSFER; SECRETARIAL APPROVAL.âA State or tribal organization which elects to make a transfer under
               subsection (a) shall notify the Secretary of Health and Human Services of such proposed transfer, including a description
               of the amount to be transferred, the purposes of the transfer, the need for the transfer, and the impact of the transfer on
               the provision of services from which the funding would be transferred. The Secretary shall approve any such transfer unless
               the Secretary determines that such transfer is not consistent with the objectives of the OAA. 
      (c)  RULES OF CONSTRUCTION.âNo transfer of grant funds by a State or tribal organization under this section shall be construedâ (1)  as inconsistent with the authorized use of such funds under the OAA, including for purposes of OAA administration and oversight
                  by the Secretary; or 
         (2)  to relieve the State or tribal organization from applicable reporting requirements under the OAA regarding the use of such
                  funds. 
      SEC. 223.   Funds available to the Secretary under this or any prior Act that are available for acquisition of real property or for construction
            or improvement of facilities shall also be available to make transportation and infrastructure related improvements on property
            located directly adjacent to property owned by the Federal Government, provided that the primary benefit of such improvements
            accrues to HHS or the component thereof funding the improvements. SEC. 224.   With respect to an individual who is serving as principal investigator on one or more grants or cooperative agreements funded
            by the National Institutes of Health (NIH) under this title, none of the funds made available to NIH by this title shall be
            used, together with any funds from the analogous title in any previous appropriations act, to pay the salary of such individual
            at a rate exceeding 90 percent of such salary. SEC. 225.   Funds appropriated in this or any prior Act or the Patient Protection and Affordable Care Act that are available for salaries
            and expenses of employees of the Department of Health and Human Services shall also be available for the primary and secondary
            schooling of eligible dependents of HHS personnel stationed in the Commonwealth of Puerto Rico, the Commonwealth of the Northern
            Mariana Islands, and the possessions of the United States at costs not in excess of those paid for or reimbursed by the Department
            of Defense.  SEC. 226.  Funds appropriated in this or any prior Act or the Patient Protection and Affordable Care Act that are available for salaries
            and expenses of employees of the Department of Health and Human Services shall also be available to pay travel and related
            expenses of such an employee or of a member of his or her family, when such employee is assigned to duty, in the United States
            or in a U.S. territory, during a period and in a location that are the subject of a determination of a public health emergency
            under section 319 of the Public Health Service Act and such travel is necessary to obtain medical care for an illness, injury,
            or medical condition that cannot be adequately addressed in that location at that time. For purposes of this section, the
            term "U.S. territory" means Guam, the Commonwealth of Puerto Rico, the Northern Mariana Islands, the Virgin Islands, American
            Samoa, or the Trust Territory of the Pacific Islands. SEC. 227.  Notwithstanding section 12(b) of the Federal Advisory Committee Act, funds made available by this Act for the "National Institutes
            of HealthâOffice of the Director" account shall also be available to establish and operate the Research Policy Board authorized
            by section 2034(f) of Public Law 114â255.